摘要
目的探讨手术治疗与保守治疗幕上高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)的临床疗效。方法回顾性分析465例幕上HICH病例资料,其中保守治疗(保守组)240例,手术治疗(手术组)225例。首先应用二元Logistic回归分析得到超早期死亡的独立危险因素。再应用倾向性评分匹配筛选出手术组和保守组各90例,采用Kaplan-Meier生存分析比较两组患者生存时间,比较发病后3、6和12个月改良Rankin量表(modified Rankin Scale,mRS)评分,以及住院期间并发症发生率、住院时间和住院费用。结果手术组平均生存时间显著长于保守组(P=0.020)。两组在发病后的3、6和12个月时mRS评分无显著差异。手术组住院时间明显长于保守组(P=0.005),住院费用也明显高于保守组(P<0.001)。在并发症方面,手术组肺炎、泌尿系感染、消化道出血发生率显著高于保守组(P<0.05)。结论手术治疗可能对幕上HICH患者的生存时间有积极影响,但与保守治疗比较,在发病后3、6和12个月时mRS评分无差异,同时手术治疗也伴随着较长住院时间、较高住院费用以及增加部分并发症的发生率。
Objective To investigate the efficacy of surgical and conservative treatments for supratentorial hypertensive intracerebral hemorrhage(HICH).Methods The clinical data of 465 patients with supratentorial HICH including 240 with conservative treatment(conservative group)and 225 surgical treatment(surgical group),were analyzed retrospectively.Binary logistic regression analysis was first applied to identify independent risk factors for ultra-early death within 7 days.Propensity score matching was then used to select 90 patients from each group for comparison.Kaplan-Meier survival analysis was employed to assess survival time between the two groups.While modified Rankin Scale(mRS)scores at 3,6,and 12 months post-onset,the incidence of complications,hospital stay and hospitalization costs during the inpatient period were compared.Results The average survival time of the surgical group was significantly longer than that of the conservative group(P=0.020).There were no significant differences in mRS scores between the two groups at 3,6,and 12 months post-onset.The surgical group had significantly longer hospital stays(P=0.005)and higher hospitalization costs(P<0.001)compared to the conservative group.In terms of complications,the surgical group had significantly higher incidences of pneumonia,urinary tract infections and gastrointestinal bleeding(P<0.05).Conclusions Surgical treatment may have a positive impact on survival time for patients with supratentorial HICH,but there were no differences in mRS scores at 3,6,and 12 months post-onset compared to conservative treatment.Additionally,surgical treatment is associated with longer hospital stays,higher hospitalization costs,and increased incidences of certain complications.
作者
练石坤
陈志生
陈志贺
谭绍涛
蓝锡昌
梁富华
高寒
Lian Shikun;Chen Zhisheng;Chen Zhihe;Tan Shaotao;Lan Xichang;Liang Fuhua;Gao Han(Department of Neurosurgery,Yunfu People's Hospital,Yunfu,Guangdong 527300,China;Department of Neurosurgery,Affiliated Qingyuan Hospital,Guangzhou Medical University,Qingyuan People's Hospital,Qingyuan,Guangdong 511518,China)
出处
《中国微侵袭神经外科杂志》
CAS
2024年第6期345-351,共7页
Chinese Journal of Minimally Invasive Neurosurgery
基金
广东省医学科学技术研究基金(编号:B2021226)。
关键词
颅内出血
高血压性
幕上
手术治疗
保守治疗
临床疗效
intracerebral hemorrhage,hypertensive
supratentorial
surgical treatment
conservative treatment
clinical efficacy
