不同的手术方式及手术时机治疗丘脑出血破入脑室临床分析(1)
DOI：10.16662/j.cnki.1674-0742.2019.35.033
[摘要] 目的 通過对于高血压脑丘脑出血破入脑室的患者的手术方式、手术时机和一般情况等作相关研究，以期为高血压丘脑出血破入脑室的患者的临床诊治提供相关的参考依据。方法 方便选取2018年1—10月在该院神经外科住院，首次经过影像学确诊的高血压丘脑出血破入脑室的患者84例，研究患者手术的GCS评分、出血部位、出血量、手术方式、手术时机、设计调查表。再与电话随访相结合的方法。随访患者家属或者患者本人，以GOS评分作为近期预后指标，以ADL分级发作为随访时评估患者生活能力的指标，采用SPSS进行数据分析。结果 格拉斯格评分高者预后明显好，GCS评分为3～8分(等级1～5的数据分别为2、8、6、2、2)与GCS评分13～14分(等级1～5的数据分别为0、0、6、12、20)相比，差异有统计学意义(χ2=4.971 P=0.000 <0.01);患者在超早期手术(6h以内52例中有48例好转)和24～48 h手术的预后(共12例数中好转例数为0)，差异有统计学意义(χ2=3.12，P=0.016 <0.05)，患者在6～24 h内手术预后(共20例数中好转例数为12)和患者在24～48 h预后(共12例数中好转例数为0)并，差异无统计学意义(χ2=2.10，P=0.319 >0.05)。患者在<6 h(共52例中有48例好转)和在6～24 h预后(共20例数中好转例数为12)状况，差异无统计学意义(χ2=4.32，P=0.129 >0.05)。开颅组(44例中34例转好)和引流组(40例中34例转好)的近期和远期预后指标GOS和ADL评分，差异无统计学意义(χ2=3.18，P=0.192 >0.05)。结论 术前患者GCS评分、出血量、手术时机、手术方式等因素与患者预后有着一定的相关性，因此，在临床上我们针对患者的具体情况进行个性化治疗，对相关问题进行强化和治疗。达到较为满意的临床治疗效果。
[关键词] 手术方式;手术时机;丘脑出血
[中图分类号] R651.1 [文献标识码] A [文章编号] 1674-0742(2019)12(b)-0033-05
Different Surgical Methods and Timing of Operation Clinical Analysis of Thalamic Hemorrhage Breaking into Ventricle
MA Yong-hui， YE Yong-zao， JIANG Yue-ming， XUE Wei-ming， GAO Xin， TAN Guo-wei， WANG Zhan-xiang
Department of Neurosurgery， the First Affiliated Hospital of Xiamen University， Xiamen， Fujian Province， 361000， China
[Abstract] Objective To provide reference for the clinical diagnosis and treatment of hypertensive thalamic hemorrhage ruptured into ventricles by studying the operation methods， timing and general conditions of patients with hypertensive thalamic hemorrhage ruptured into ventricles. Methods 84 cases of hypertensive thalamic hemorrhage ruptured into ventricles were convenient studied in our hospital from January to October 2018. The GCS score， bleeding location， bleeding volume， operation mode， operation timing and questionnaire design were studied. Then， it combines with telephone follow-up. Follow-up patients'family members or patients themselves， GOS score as a short-term prognostic index， ADL grade seizures as a follow-up index to assess patients' ability to live， using SPSS data analysis. Results The prognosis of patients with high Glasgow score was significantly better. The GCS score was 3-8 (grade 1-5 data were 2， 8， 6， 2， 2) and the GCS score was 13-14 (grade 1-5 data were 0， 0， 6， 12， 20)， respectively. There were significant differences between the twothe difference was statistically significant (χ2=4.971，P=0.000<0.01); the prognosis of patients with super-early surgery (48 out of 52 cases within 6 hours) and 24-48 hours surgery (12 cases in total). There was no significant difference in prognosis within 6-24 hours (12 out of 20 cases improved) and 24-48 hours (0 out of 12 cases improved).the difference was not statistically significant (χ2=2.10，P=0.319>0.05). There was no significant difference in the prognosis of patients less than 6 hours (48 out of 52 cases improved) and 6-24 hours (12 out of 20 cases improved).the difference wasnotstatistically significant(χ2=4.32，P=0.129 >0.05). There was no significant difference in GOS and ADL scores between craniotomy group (34 out of 44 cases improved) and drainage group (34 out of 40 cases improved) the difference was not statistically significant(χ2=3.18，P=0.192 >0.05). Conclusion Preoperative GCS score， bleeding volume， timing of operation， operation mode and other factors have a certain correlation with the prognosis of patients. Therefore， in clinical practice， we should personalize the treatment according to the specific situation of patients， strengthen and treat the related problems. To achieve a more satisfactory clinical effect., http://www.100md.com(马永会，叶永造，姜月明，薛伟明，高鑫，谭国伟，王占祥)
[摘要] 目的 通過对于高血压脑丘脑出血破入脑室的患者的手术方式、手术时机和一般情况等作相关研究，以期为高血压丘脑出血破入脑室的患者的临床诊治提供相关的参考依据。方法 方便选取2018年1—10月在该院神经外科住院，首次经过影像学确诊的高血压丘脑出血破入脑室的患者84例，研究患者手术的GCS评分、出血部位、出血量、手术方式、手术时机、设计调查表。再与电话随访相结合的方法。随访患者家属或者患者本人，以GOS评分作为近期预后指标，以ADL分级发作为随访时评估患者生活能力的指标，采用SPSS进行数据分析。结果 格拉斯格评分高者预后明显好，GCS评分为3～8分(等级1～5的数据分别为2、8、6、2、2)与GCS评分13～14分(等级1～5的数据分别为0、0、6、12、20)相比，差异有统计学意义(χ2=4.971 P=0.000 <0.01);患者在超早期手术(6h以内52例中有48例好转)和24～48 h手术的预后(共12例数中好转例数为0)，差异有统计学意义(χ2=3.12，P=0.016 <0.05)，患者在6～24 h内手术预后(共20例数中好转例数为12)和患者在24～48 h预后(共12例数中好转例数为0)并，差异无统计学意义(χ2=2.10，P=0.319 >0.05)。患者在<6 h(共52例中有48例好转)和在6～24 h预后(共20例数中好转例数为12)状况，差异无统计学意义(χ2=4.32，P=0.129 >0.05)。开颅组(44例中34例转好)和引流组(40例中34例转好)的近期和远期预后指标GOS和ADL评分，差异无统计学意义(χ2=3.18，P=0.192 >0.05)。结论 术前患者GCS评分、出血量、手术时机、手术方式等因素与患者预后有着一定的相关性，因此，在临床上我们针对患者的具体情况进行个性化治疗，对相关问题进行强化和治疗。达到较为满意的临床治疗效果。
[关键词] 手术方式;手术时机;丘脑出血
[中图分类号] R651.1 [文献标识码] A [文章编号] 1674-0742(2019)12(b)-0033-05
Different Surgical Methods and Timing of Operation Clinical Analysis of Thalamic Hemorrhage Breaking into Ventricle
MA Yong-hui， YE Yong-zao， JIANG Yue-ming， XUE Wei-ming， GAO Xin， TAN Guo-wei， WANG Zhan-xiang
Department of Neurosurgery， the First Affiliated Hospital of Xiamen University， Xiamen， Fujian Province， 361000， China
[Abstract] Objective To provide reference for the clinical diagnosis and treatment of hypertensive thalamic hemorrhage ruptured into ventricles by studying the operation methods， timing and general conditions of patients with hypertensive thalamic hemorrhage ruptured into ventricles. Methods 84 cases of hypertensive thalamic hemorrhage ruptured into ventricles were convenient studied in our hospital from January to October 2018. The GCS score， bleeding location， bleeding volume， operation mode， operation timing and questionnaire design were studied. Then， it combines with telephone follow-up. Follow-up patients'family members or patients themselves， GOS score as a short-term prognostic index， ADL grade seizures as a follow-up index to assess patients' ability to live， using SPSS data analysis. Results The prognosis of patients with high Glasgow score was significantly better. The GCS score was 3-8 (grade 1-5 data were 2， 8， 6， 2， 2) and the GCS score was 13-14 (grade 1-5 data were 0， 0， 6， 12， 20)， respectively. There were significant differences between the twothe difference was statistically significant (χ2=4.971，P=0.000<0.01); the prognosis of patients with super-early surgery (48 out of 52 cases within 6 hours) and 24-48 hours surgery (12 cases in total). There was no significant difference in prognosis within 6-24 hours (12 out of 20 cases improved) and 24-48 hours (0 out of 12 cases improved).the difference was not statistically significant (χ2=2.10，P=0.319>0.05). There was no significant difference in the prognosis of patients less than 6 hours (48 out of 52 cases improved) and 6-24 hours (12 out of 20 cases improved).the difference wasnotstatistically significant(χ2=4.32，P=0.129 >0.05). There was no significant difference in GOS and ADL scores between craniotomy group (34 out of 44 cases improved) and drainage group (34 out of 40 cases improved) the difference was not statistically significant(χ2=3.18，P=0.192 >0.05). Conclusion Preoperative GCS score， bleeding volume， timing of operation， operation mode and other factors have a certain correlation with the prognosis of patients. Therefore， in clinical practice， we should personalize the treatment according to the specific situation of patients， strengthen and treat the related problems. To achieve a more satisfactory clinical effect., http://www.100md.com(马永会，叶永造，姜月明，薛伟明，高鑫，谭国伟，王占祥)