高血压脑出血手术适应证分析及疗效探讨

摘要

目的 总结分析四川大学华西医院2006-2009年高血压脑出血(HICH)患者的临床资料,比较HICH手术治疗与保守治疗的疗效及预后,探讨该病的手术及保守治疗的适应证.方法 回顾性分析1237例HICH患者,对不同病情级别组的HICH患者手术治疗与保守治疗的疗效及预后进行比较.结果 手术组患者的整体病情重于保守治疗组患者;手术组患者整体预后均低于保守组.对于病情特重组(GCS 3分)手术与保守治疗对预后的影响差异无统计学意义;对于病情特重组(GCS4分)和病情重组(GCS 5～7分)手术治疗可降低死亡率,改善远期预后及生活能力;对于病情中等组(GCS 8～10分)和病情轻组(GCS 11分以上)保守治疗较手术治疗疗效佳.结论 对于病情较轻者(GCS 11分以上)和病情中等者(GCS 8～10分)手术组死亡率高于保守组,以保守治疗为佳;对于病情特重者(GCS 4分)和病情较重者(GCS 5～7分)应尽快手术治疗;对于GCS 3分患者治疗方式的选择还有待进一步探讨.%Objective To analyze the clinical datns of patients who suffered with hypertensive cerebral hemorrhage(HICH) in West China Hospital of Sichuan University from 2006 to 2009,to evaluate the efficacy and prognosis of surgical treatment and conservative treatment in HICH, to investigate thesurgical and conservative treatment Indications. Method A retrospective analysis of 1 237 cases of HICH of department of Neurosurgery,West China Hospital of Sichuan University from 2006 to 2009. The efficacy and prognosis of surgical treatment and conservative treatment in the different levels group of patients with HICH were compared. Results The state of illness of surgical goup was more severe than conservative treatment group. The overall prognosis of surgical group were worse than the conservative group. For the most severe group ( GCS 3 points ), there was no significant difference in prognosis between surgical group and conservative group;for the other most severe group( GCS 4points) and more severe group(GCS 5 ～7 points) ,surgery can reduce the death rate and improve the long -term prognosis and viability. For moderate group (GCS 8 ～ 10 points ) and mild group (GCS 11 points above),conservative treatment was better than surgical treatment. Conclusions For mild group(GCS 11 points above)and moderate group(GCS8 ～ 10 points) ,the surgical mortality was higher than conservative groups,conservative treatment is preferred. For the most severe group(GCS 4 points) and more severe group(GCS 5 ～7 points),surgery should be performed as soon as possible;the selection of treatment in patients with CCS 3 points requested to be further research.