目的 探究小骨窗显微手术治疗高血压脑出血的最佳手术时机.方法 连续纳入2010年6月至2014年6月来我院神经外科高血压脑出血发病24 h内接受小骨窗显微手术治疗患者.前瞻性队列研究方法进行研究设计,根据入院接受手术时间分为对照组(＞6h)27例及研究组(≤6h) 31例.两组患者均全麻下进行小骨窗开颅显微手术.术后1周内检测死亡、并发症及再出血例数.手术前后对患者进行GOS评分,手术后1周及半年对患者进行随访,并进行ADL评分及WHOQOL-BREF评分.结果 术前两组GOS评分无统计学差异(P＞0.05),术后研究组患者GOS评分显著高于对照组(P＜0.05).术后1周,两组ADL评分无统计学差异(P＞0.05);术后半年,研究组患者ADL评分显著高于对照组(P＜0.05).术后1周,两组WHOQOL-BREF评分无统计学差异(P＞0.05);术后半年,研究组患者WHOQOL-BREF评分显著高于对照组(P＜0.05).通过多重线性回归发现,在校正性别、年龄、术前GOS评分后,手术时机与术后GOS评分呈线性关系,发病到手术的时间越短,其术后GOS评分越高(P＜0.05).结论 发病到手术的时间越短,患者术后预后越好,在发病后6h内进行手术能够显著提高患者的预后,促进日常生活活动功能的恢复,提高患者的生存质量,具有重要意义.%Objective To explore the optimal operation time of small skull window micro-surgical operation in the treatment of hypertensive intracerebral hemorrhage (HICH).Methods Consecutively included patients with HICH who underwent small skull window micro-surgical operation within 24 h admitted in department of neurosurgery of our hospital from June 2010 to June 2014.The study was designed with prospective cohort study method.According to the operation time,all patients were divided into control group (more than 6 h,27 cases) and study group (within 6 h,31 cases).Under general anesthesia,patients in both groups underwent small skull window micro-surgical operation.Within 1 week after operation,the mortality,the incidences of complications and re-bleeding were recorded;recorded patients' GOS score before and after operation;recorded patients' ADL score and WHOQOL-BREF score 1 week and half a year after operation.Results There was no statistically significant difference in GOS score between two groups before operation (P＞0.05);GOS score in study group was significantly higher than that in control group after operation (P＜0.05).1 week after operation,there were no statistically significant differences in ADL score and WHOQOL-BREF score between two groups (P＞0.05);6 months after operation,ADL score and WHOQOL-BREF score in study group were significantly higher than those in control group (P＜0.05).After adjusting factors,there was linear relationship between operation time and postoperative GOS score (P＜0.05).Conclusion The shorter the operation time is,the better the prognosis of patients is.The operation within 6 h can significantly improve the prognosis of patients,the recovery of activities of daily living,the quality of life,which has important significance in clinical application.
展开▼
