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脑出血微创血肿抽吸引流治疗的最佳时机探讨
http://www.100md.com 2004年9月13日 中国危重病急救医学2004年9月第16卷第9期
     刘丽军 薛占苍 杨国卿 张秀明

    【摘要】 目的 寻找脑出血微创颅内血肿抽吸引流治疗的最佳时机。方法 126例脑出血患者按手术超早期(发病6 h内,69例)、早期(发病6~24 h,57例)分成两组,采用欧洲卒中量表(ESS)、Bartherl指数(BI)评价神经功能恢复状况。结果 手术前两组ESS评分,伴发病、既往史评分及两组不同部位(壳核、丘脑、脑叶)出血量比较无统计学差异。发病后1个月(排除已死亡者),超早期组ESS评分(64.76±7.12)分和BI平均值(66.39±7.23)均明显高于早期组(分别为(59.21±8.63)分和61.91±8.31(P均<0.01));发病后3个月时超早期组BI平均值(79.46±13.29)也明显高于早期组(72.32±11.86),P<0.01。超早期组比早期组疗效好,两组病死率比较无统计学差异。结论对于有手术适应证的脑出血患者,应尽可能在6 h内行超早期颅内血肿抽吸引流治疗。

    【关键词】 脑出血; 抽吸引流术; 微创手术; 最佳时机

    Optimal time window for minimally invasive aspiration and drainage of the hematoma in patients with intracerebral hemorrhage

    LIU Li-jun, XUE Zhan-cang, YANG Guo-qing, ZHANG

    Xiu-ming. The First Municipal Hospital, Shijiazhuang 050011, Hebei, China

    【Abstract】 Objective To seek the optimal time window for minimally invasive aspiration and drainage of the hematoma in patients with intracerebral hemorrhage. Methods One hundred and twenty-six patients with intracerebral hemorrhage were divided into two groups in terms of the operation time window: ultra-early stage group(within 6 hours) and early stage group (6-24 hours). European stroke scale(ESS) score and Bartherl index(BI) were used to evaluate the improvement of neurological function. Results There were no significant differences between the two groups in ESS score, complications, and past medical history on hospital admission. Also no difference existed in the volume of hematoma in different regions of the brain between the two groups, including putamen thalamus and brain lobes. However, one month after the onset, mean ESS score was 64.76±7.12 and the mean BI was 66.39±7.23 in the ultra-early stage group (non-survivors were excluded), whereas in the early stage group, they were 59.21±8.63 and 61.91±8.31 (non-survivors were excluded too), respectively (both P<0.01). Three months after the mean BI was 79.46±13.29 in the ultra-super early stage group and 72.32±11.86in the early stage group, and the difference in the two groups was significant(P<0.01). Though surgery in the ultra-early stage gave better results than that in early stage, no marked difference in mortality was found between the two groups(P>0.05). Conclusion The aspiration and drainage of the hematoma should be done as early as possible(within 6 hours of the onset) provided that the patients are fit to undergo the surgery. ......

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