陈军 李爱民 吴海滨 颜士卫 陈覃 司宪平 施辉 王富元 江伟 刘希光 孙维晔
摘要：目的 研究高血压脑出血最佳手术时机。方法 1000例高血压性脑出血，内科组507例，外科组493例。按发病-治疗时间分为：超早期组(≤7h)，早期组(7～24h)和晚期组(＞24h)共3 组，分别进行内、外科疗效比较和组间外科疗效比较。疗效判定指标为：近期疗效、远期疗效、病死率、优良率和并发症发生率等。结果 (1) 超早期组和早期组，手术疗效优于内科治疗；(2) 超早期组和早期组，手术疗效无显著差异；（3）超早期组术后颅内再出血风险高，早期组再出血率下降；（4）晚期组，外科组的呼吸、泌尿和消化系统并发症发生率高于内科组。结论 高血压脑出血发病后早期（7～24h），是最佳手术时机。
The optimization of time course for surgical treatment of hypertensive intracerebral hemorrhage CHEN Jun, LI Aimin, WU Haibin, etal. Department of Neurosurgery,Lianyungang First Hosipital,Xuzhou Medical College, Lianyungang 222002,Jiangsu,China
Abstract: Objective To determine the optimal time course for surgical treatment of hypertensive intracerebral hemorrhage(ICH). Methods Among all 1000 cases of ICH, there were 507 cases for medical treatment and 493 cases for surgical treatment. According to the time course after imitial onset, they were divided into three groups, which were Ultra-early group(≤7h)，early group(7~24h), and Delay group(＞24h). The near-term outcome (GOS scale), lon-term outcome(Barthel scale), mortality, as well as incidence of associated complications were compared respectively. Results (1) In the Ultra-early group and early group, both the near-term and lon-term outcome of surgical treatment was definitely better than medical treatment. (2) For the outcome of surgical treatment, there was no significantly difference between Ultra-early and early groups.(3) In the Ultra-early group,the risk of recurrent post-operative hemorrage was higher,and decreased benceforth. (4) In the Delay group,the incidence of associated complications of respiratory,urinary and gastrointestinal system was higher for surgery than medication.Conclusion The early stage (7~24h) was the optimal time course for surgical treatment of intracerebral hemorrhage.
Key words: cerebral hemorrhage; hypertention;surgery; time facts