摘要：

目的 探讨入院时Glasgow 昏迷量表（GCS）评分对高血压性脑出血患者急救策略的影响。 方法 共286 例高血压性脑出血患者中186 例接受手术治疗，包括GCS 评分5 ~ 8 分94 例、9 ~ 11 分71 例和12 ~ 14 分21 例，分别予血肿清除术联合去骨瓣减压术（63 例，22.03%）、单纯血肿清除术（21 例，7.34%）和血肿钻孔引流术或脑室外引流术（102例，35.66%）；100例接受保守治疗，包括GCS评分5 ~ 8分25 例、9 ~ 11 分27 例、12 ~ 14 分25 例和15 分23 例。随访3 ~ 6 个月，采用Glasgow 预后分级（GOS）评价疗效。 结果 GCS 评分5 ~ 8 分组失访6 例（5.04%），GOS 分级1 级14 例（11.76%）、2 级21 例（17.65%）、3 级39 例（32.77%）、4 级22 例（18.49%）、5 级17 例（14.29%）；GCS 评分9 ~ 11 分组失访2 例（2.04%），GOS 分级1 级6 例（6.12%）、2 级2 例（2.04%）、3 级6 例（6.12%）、4 级48 例（48.98%）、5 级34 例（34.69%）；GCS 评分12 ~ 14 组GOS 分级4 级15 例（32.61%）、5 级31 例（67.39%）；GCS 评分15 分组GOS 分级4 级1 例（4.35%）、5 级22 例（95.65%），组间差异具有统计学意义（χ² = 142.966，P = 0.000）。 结论 高血压性脑出血患者入院时GCS评分与其预后呈正相关，GCS评分越高、GOS分级越高。

关键词: 格拉斯哥昏迷量表, 颅内出血, 高血压性, 急救, 颅骨切开术, 减压术, 外科, 引流术

Abstract:

Objective  To investigate the effect of Glasgow Coma Scale (GCS) on the choice of treatment strategy in acute hypertensive intracerebral hemorrhage.  Methods  Among 286 patients with hypertensive intracerebral hemorrhage, 186 patients underwent operation. According to GCS scores on admission, 186 cases included 94 cases of GCS 5-8, 71 cases of GCS 9-11 and 21 cases of GCS 12-14. These patients respectively underwent hematoma clearance and decompressive craniotomy (N = 63, 22.03%), hematoma clearance (N = 21, 7.34%), trepanation and drainage or external ventricular drainage (N = 102, 35.66%). The rest (N = 100) underwent conservative treatment, including 25 cases of GCS 5-8, 27 cases of GCS 9-11, 25 cases of GCS 12-14 and 23 cases of GCS 15. Glasgow Outcome Scale (GOS) was used to evaluate curative effect after 3-6 months follow-up.  Results  The proportion of GOS in GCS 5-8 group was 14 cases (11.76%) of Grade 1, 21 cases (17.65%) of Grade 2, 39 cases (32.77%) of Grade 3, 22 cases (18.49%) of Grade 4 and 17 cases (14.29%) of Grade 5, except 6 lost cases (5.04%). The proportion of GOS in GCS 9-11 group was 6 cases (6.12%) of Grade 1, 2 cases (2.04%) of Grade 2, 6 cases (6.12%) of Grade 3, 48 cases (48.98%) of Grade 4 and 34 cases (34.69%) of Grade 5, except 2 lost cases (2.04%). The proportion of GOS in GCS 12-14 group was 15 cases (32.61%) of Grade 4 and 31 cases (67.39%) of Grade 5. The proportion of GOS in GCS 15 group was one case (4.35%) of Grade 4 and 22 cases (95.65%) of Grade 5. Differences between groups had statistical significance ( χ ² = 142.966, P = 0.000).  Conclusions  The prognosis of patients with hypertensive intracerebral hemorrhage is positively related to GCS score on admission. The higher the GCS score is, the higher the GOS grade will be.

Key words: Glasgow Coma Scale, Intracranial hemorrhage, hypertensive, First aid, Craniotomy, Decompression, surgical, Drainage