重症高血压脑出血手术治疗时机及预后分析

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1、中国康复·2010年4月·第25卷第2期1l5重症高血压脑出血手术治疗时机及预后分析高晨，周敏慧，刘耀明，贺云飞，马宝平【摘要】目的：探讨治疗重症高血压脑出血患者的手术时机及方式与疗效的关系。方法：回顾性分析140例重症高血压脑出血手术患者，根据发病至手术时间分为超早期(出血<7h)手术66例(A组)，早期(出血8～24h)手术40例(B组)及延迟(出血>24h)手术34例(C组)；根据出血部位，出血量及血肿是否破入脑室，而选择小骨窗开颅血肿清除术、开颅血肿清除并去骨板减压术或单侧或双侧脑室外引流术等术式。术后平均随访2年，按ADL能力分级法评定患者生存状况

2、。结果：按ADL能力分级法，A组及B组ADL达1～3级比率明显高于c组，死亡率明显低于C组(均P

3、ypertensionCerebralHemorrhageGAOChen，ZHOUMin—hui，L儿，Yao—ming，eta1．DepartmentofNeurosurgery，GeneralHospitalofLanzhouMili—taryCommand，Ianzhou730070。China[Abstract]Objective：Toexploretherelationofsurgicalmethodsandoccasionsforthepatientswithefficacyofseverehyperten—sioncerebralhemorrh

4、age．Methods：Theclinicaldataof140patientswithseverehypertensioncerebralhemorhagesubjecttosurgi—caltherapywereanalyzedretrospectively．Accordingtothetimecourseofsurgery，theyweredividedintothreegroups：ultra-earlygroup(receivingtheoperationswithin7h。66cases)，earlygroup(receivingtheopera

5、tionswithin7to24h．40cases)anddelayedgroup(receiving：theoperationsafter24h，34cases)．Inaccordancewithbleedingsite，theamountofbleedingandwhetherhema—tomabrokeintotheventricle，thesmallbonewindowofcraniotomyhematoma，craniotomyandhematomabonelessboarddecom—pression，unilateralortwoqateral

6、ventricledrainagetreatmentwerechosen．IXtringtheaverage2-yearfollo~Lup，therecoveryandactivitiesofdailyliving(ADL)afterthesurgerywereobserved．Results：InaccordancewiththeclassificationofADI，patientsinultra—earlygroupandearlygroupshowedhigherlevelofclassIto1Ithanthoseindelayedgroup(P

7、．05)．Patientsinultra-earlygroupshowedlowerlevelofclassIVandVanddeathratethanthoseindelayedgroup(PO．05)．TherewasnoobviousdifferencebetweenearlygroupanddefergroupinclassVyet．Conclusion：Thec

8、hoiceofpropermethodsandocc