摘要：

目的 探讨血肿穿刺置管引流术治疗时机对重症脑出血患者神经功能缺损程度、日常生活活动能力、并发症和病死率的影响。方法 共 90 例重症脑出血患者分别于发病 7 h 内（38 例）和发病7 h 后（52 例）行血肿穿刺置管引流术，采用美国国立卫生研究院卒中量表（NIHSS）、中国卒中量表（CSS）和 Glasgow 昏迷量表（GCS）评价神经功能缺损程度，Barthel 指数（BI）评价日常生活活动能力，并记录术后并发症（包括血糖升高、肺部感染、泌尿系统感染和消化道出血）和病死率。结果 两组患者术后NIHSS 评分（P = 0.000）、CSS 评分（P = 0.000）和 GCS 评分（P = 0.000）低于，BI 评分高于（P = 0.000）术前；发病 7 h 内治疗组患者 NIHSS 评分（P = 0.000）、CSS 评分（P = 0.000）和 GCS 评分（P = 0.000）低于，BI 评分高于（P = 0.000）发病 7 h 后治疗组。发病 7 h 内治疗组患者术后血糖升高［21.05%（8/38）对 51.92%（27/52）；χ² = 8.804，P = 0.003］、肺部感染［15.79%（6/38）对 46.15%（24/52）；χ² = 9.109，P = 0.003］、泌尿系统感染［5.26%（2/38）对 44.23%（23/52）；χ² = 16.618，P = 0.000］、消化道出血［10.53%（4/38）对 28.85%（15/52）；χ² = 4.424，P = 0.035］等并发症发生率和病死率［13.16%（5/38）对 38.46%（20/52）；χ² = 7.007，P = 0.008］均低于发病7 h后治疗组。结论 超早期血肿穿刺置管引流术治疗重症脑出血可以有效改善神经功能，提高日常生活活动能力，减少并发症和降低病死率。

关键词:  , 脑出血, 引流术, 预后

Abstract:

Objective To investigate the influence of the timing of hematoma puncture and catheter drainage on neurological impairment, activities of daily living (ADL), complications and mortality of patients with severe intracerebral hemorrhage (ICH). Methods A total of 90 patients with severe ICH in our hospital were enrolled and divided into 2 groups by operation timing including < 7 h group (N = 38) undergoing hematoma puncture and catheter drainage for < 7 h after ICH and ≥ 7 h group (N = 52) undergoing the same procedure for ≥ 7 h after ICH. National Institutes of Health Stroke Scale (NIHSS), Chinese Stroke Scale (CSS) and Glasgow Coma Scale (GCS) were used to assess neurological impairment. Barthel Index (BI) was used to assess ADL, and postoperative complications (including elevated blood glucose, pulmonary infection, urinary tract infection and digestive tract bleeding) and mortality were recorded. Results The NIHSS scores (P = 0.000), CSS scores (P = 0.000) and GCS scores (P = 0.000) after operation of 2 groups were significantly lower, while BI scores were significantly higher (P = 0.000) than before operation. The NIHSS scores (P = 0.000), CSS scores (P = 0.000) and GCS scores (P = 0.000) after operation of < 7 h group were significantly lower, while BI scores were significantly higher (P = 0.000) than those of ≥ 7 h group. The incidence of elevated blood glucose [21.05% (8/38) vs. 51.92% (27/52); χ² = 8.804, P = 0.003], pulmonary infection [15.79% (6/38) vs. 46.15% (24/52); χ² = 9.109, P = 0.003], urinary tract infection [5.26% (2/38) vs. 44.23% (23/52); χ² = 16.618, P = 0.000] and digestive tract bleeding [10.53% (4/38) vs. 28.85% (15/52); χ² = 4.424, P = 0.035] and mortality [13.16% (5/38) vs. 38.46% (20/52); χ² = 7.007, P = 0.008] of < 7 h group were significantly lower than those of ≥7 h group. Conclusions Hematoma puncture and catheter drainage at ultra-early stage in treatment of patients with severe ICH can efficiently improve neurological function and the quality of life, and reduce complications and mortality.

Key words: Cerebral hemorrhage, Drainage, Prognosis