超早期神经内镜手术对高血压脑出血患者神经功能及生活质量的影响

徐文华 方富 刘卫兵 梁锐

[摘要] 目的 探討高血压脑出血超早期神经内镜手术对患者神经功能及生活质量的影响。 方法 回顾性选取2016年6月至2020年6月本院高血压脑出血患者60例，依据神经内镜手术时机分为超早期组（出血7 h内）和延迟期组（出血24 h后），每组各30例，统计分析两组患者的手术相关指标、血肿清除、意识恢复、致残、死亡情况、神经功能、精神状态、日常生活活动能力、生活质量、临床疗效、术后并发症发生情况。 结果 超早期组患者的手术时间、入住ICU时间、住院时间均显著短于延迟期组（P<0.05），术中出血量显著少于延迟期组（P<0.05），血肿清除率、意识恢复率为93.3%（28/30）、86.7%（26/30），均显著高于延迟期组的80.0%（24/30）、56.7%（17/30）（P<0.05），致残率为13.3%（4/30）显著低于延迟期组的43.3%（13/30）（P<0.05），超早期组手术后较手术前的ESS评分、MMSE评分、BI评分、SF-36评分升高幅度均显著高于延迟期组（P<0.05），超早期组总有效率为90.0%（27/30），显著高于延迟期组的63.3%（19/30）（P<0.05），超早期组术后并发症总发生率为16.7%（5/30），显著低于延迟期组的46.7%（14/30）（P<0.05）。 结论 高血压脑出血超早期神经内镜手术较延迟期神经内镜手术更能有效改善患者神经功能及生活质量。

[关键词] 高血压脑出血;超早期;神经内镜手术;神经功能;生活质量

[中图分类号] R743.34          [文献标识码] B          [文章编号] 1673-9701（2021）35-0055-03

Effect of super-early neuroendoscopic surgery on nerve function and quality of life in patients with hypertensive cerebral hemorrhage

XU Wenhua   FANG Fu   LIU Weibing   LIANG Rui

Department of Neurosurgery，Jiujiang NO.1 People's Hospital in Jiangxi Province，Jiujiang   332000，China

[Abstract] Objective To investigate the effect of ultra-early neuroendoscopic surgery on patients with hypertensive cerebral hemorrhage on neurological function and quality of life. Methods Sixty patients with hypertensive cerebral hemorrhage in our hospital from June 2016 to June 2020 were retrospectively selected. According to the timing of neuroendoscopic surgery， they were divided into the super-early group（bleeding within 7 hours） and the delayed group（bleeding over 24 h）， with 30 cases in each group. The operation-related indicators， hematoma removal， recovery of consciousness， disability， death， neurological function， mental state， activities of daily living， quality of life， clinical efficacy， postoperative complications between the two groups were statistically analyzed. Results The operation time，the time of admission to the intensive care unit， and the length of hospital stay in the super-early group were significantly shorter than those in the delayed group（P<0.05）. The intraoperative blood loss in the super-earty group was significantly less than that in the delayed group（P<0.05）. The hematoma clearance rate 93.3%（28/30）， and the consciousness recovery rate 86.7%（26/30） in the super-early group were significantly higher than those of （80.0%[24/30] and 56.7% [17/30]） in the delayed group（P<0.05）. The disability rate in the super-early group was 13.3%（4/30）， which was significantly lower than that of 43.3%（13/30） in the delayed group （P<0.05）. The increase in ESS score， MMSE score， BI score， and SF-36 score after surgery was significantly higher in the super-early group than that in the delayed group （P<0.05）. The total effective rate of 90.0% （27/30） in the super-early group was significantly higher than that of 63.3%（19/30） in the delayed group （P<0.05）. The total postoperative complication rate in the super-early group was 16.7%（5/30）， which was significantly lower than that of 46.7%（14/30） in the delayed group（P<0.05）. Conclusion Super-early neuroendoscopic surgery for hypertensive intracerebral hemorrhage is more effective in improving the neurological function and quality of life of patients than delayed neuroendoscopic surgery.

[Key words] Hypertensive cerebral hemorrhage; Super-early period; Neuroendoscopic surgery; Nerve function; Quality of life

高血压脑出血属于一种出血性疾病，原发于脑实质内，在高血压后继发，在高血压并发症中最为严重，患者具有较为严重的病情、较急的发病、较高的病死率等[1]。现阶段，临床仍然没有统一手术治疗高血压脑出血的时机[2]。为了对高血压脑出血进行尽早治疗，从而有效提升患者生存率，改善患者预后，本研究统计分析2016年6月至2020年6月本院高血压脑出血患者60例的临床资料，探讨高血压脑出血超早期神经内镜手术对患者神经功能及生活质量的影响，现报道如下。……