摘要： 研究背景 我国高血压脑出血疾病负担较重，近年发病年龄呈现年轻化趋势。回顾总结中青年高血压脑出血的临床特点、对比分析各种治疗方案之有效性和安全性，可为制定治疗方案提供参考。方法 纳入天津市环湖医院2020年1月1日至2021年12月31日诊断与治疗的120例中青年（18 ~ 59岁）高血压脑出血患者，根据病情严重程度分为非手术组（22例）、钻孔引流组（47例）和内镜手术组（51例），记录术后血肿清除率、引流管留置时间、住院时间、出院时Glasgow昏迷量表（GCS）评分，以及术后并发症发生率，出院后3和6个月采用改良Rankin量表（mRS）评价神经功能预后。结果 不同治疗组患者住院时间（H = 3.445，P = 0.000）、出院时GCS评分（H = 15.767，P = 0.000）、术后支气管肺炎（χ² = 19.336，P = 0.000）和低蛋白血症（χ² = 17.650，P = 0.000）发生率，以及出院后3个月（H = 9.651，P = 0.008）和6个月（H = 8.962，P = 0.011）时mRS评分差异均具有统计学意义；与非手术组相比，内镜手术组和钻孔引流组住院时间缩短（Z = 3.816，P = 0.000；Z = 3.254，P = 0.000）、出院时GCS评分降低（Z = 3.795，P = 0.000；Z = 3.104，P = 0.002）、术后支气管肺炎（χ² = 17.223，P = 0.000；χ² = 10.251，P = 0.001）和低蛋白血症（χ² = 13.310，P = 0.000）发生率升高，且出院3个月时mRS评分增加（Z = 2.783，P = 0.009；Z = 2.270，P = 0.035），但至出院6个月时mRS评分接近非手术组（均P > 0.05）。两种手术方式相比，内镜手术组血肿清除率高于（Z = - 6.424，P = 0.000）、引流管留置时间短于（Z = - 3.856，P = 0.000）钻孔引流组；而住院时间、出院时GCS评分，术后颅内再出血、癫痫发作、颅内感染、上消化道应激性溃疡伴出血、水电解质代谢紊乱、低蛋白血症、下肢深静脉血栓形成等并发症发生率，以及出院后3和6个月时mRS评分差异无统计学意义（均P > 0.05）。结论 中青年脑出血患者普遍存在控制不良的高血压和不良生活习惯，微创手术（血肿钻孔引流术和内镜下血肿清除术）安全可靠。

关键词: 颅内出血, 高血压性, 药物疗法, 血肿, 引流术, 神经内窥镜检查, 青年人, 中年人

Abstract: Objective The disease burden of hypertensive cerebral hemorrhage was heavy, and the age of hypertensive cerebral hemorrhage patients was trending younger in China. This paper retrospectively analyzed the clinical data of a group of young and middle-aged adults with hypertensive cerebral hemorrhage, and made a detailed analysis of its clinical characteristics, so as to provide reference for the development of treatment programs.Methods A total of 120 young and middle-aged adults with hypertensive cerebral hemorrhage admitted in Tianjin Huanhu Hospital from January 1, 2020 to December 31, 2021 were included. According to severity of the disease, 120 patients were divided into non-surgery group (n = 22), borehole drainage group (n = 47) and endoscopic surgery group (n = 51). The postoperative hematoma clearance rate, drainage tube indwelling time, length of hospital stay, Glasgow Coma Scale (GCS) score at discharge, and incidence of postoperative complications were recorded. The modified Rankin Scale (mRS) was used to evaluate the prognosis at 3 and 6 months after discharge.Results The length of hospital stay (H = 3.445, P = 0.000), GCS score at discharge (H = 15.767, P = 0.000), the incidence of postoperative bronchoppneumonitis (χ² = 19.336, P = 0.000) and hypoproteinemia (χ² = 17.650, P = 0.000), mRS scores at 3 months (H = 9.651, P = 0.008) and 6 months (H = 8.962, P = 0.011) after discharge in different groups were significant differences. Compared with the non-surgery group, the length of hospital stay was shorter in the endoscopic surgery group and the borehole drainage group (Z = 3.816, P = 0.000; Z = 3.254, P = 0.000), and GCS score at discharge decreased (Z = 3.795, P = 0.000; Z = 3.104, P = 0.002), postoperative bronchopneumonia (χ² = 17.223, P = 0.000; χ² = 10.251, P = 0.001) and hypoproteinemia (χ² = 13.310, P = 0.000) increased, and mRS score at 3 months after discharge increased (Z = 2.783, P = 0.009; Z = 2.270, P = 0.035), but the mRS score at 6 months after discharge was close to that of the non-surgery group (P > 0.05, for all). Compared with the two surgical methods, the hematoma clearance rate of the endoscopic surgery group was higher than that of the borehole drainage group (Z =-6.424, P = 0.000), and the induration time of the drainage tube was shorter than that of the borehole drainage group (Z =-3.856, P = 0.000). There were no significant differences in the length of hospital stay, GCS score at discharge, postoperative intracranial rebleeding, seizures, intracranial infection, upper gastrointestinal stress ulcer with bleeding, water and electrolyte metabolism disorders, hypoproteinemia, lower extremity deep vein thrombosis and other complications, and mRS score at 3 and 6 months after discharge (P > 0.05, for all).Conclusions Poorly controlled hypertension and bad living habits are common in young and middle-aged adults with intracerebral hemorrhage. Minimally invasive surgery (drilling and drainage of hematoma and endoscopic hematoma removal) is safe and reliable.

Key words: Intracranial hemorrhage, hypertensive, Drug therapy, Hematoma, Drainage, Neuroendoscopy, Young adult, Middle aged