中等量高血壓腦出血微創(chuàng)與藥物治療療效的比較
發(fā)布時間：2018-11-18 13:54
【摘要】：目的:通過對中等量高血壓腦出血患者的治療方法以及手術時期的效果進行分析研究,確定中等量腦出血患者的治療方法,以及治療時期。方法:回顧性選取我院2012年至2015年收治的324例中等量高血壓腦出血患者,作為研究對象。男198例,女126例。年齡在45歲至65歲之間,平均年齡(56±3.8),將參加研究的所有患者平均分為2組,微創(chuàng)治療組和藥物治療組。微創(chuàng)組給予軟通道微創(chuàng)血腫清除術治療,藥物組給予保守療法進行常規(guī)治療。在治療前及治療后1周,2周,4周分別對兩組患者進行GCS昏迷指數(shù)評分和NIHSS神經功能評分并且進行分析。術后第4周對兩組患者按照日常生活能力分級法(activitiesdaily living,ADL)進行評分,對比兩組患者治療后的并發(fā)癥情況進行總結�？偨Y微創(chuàng)組患者不同手術時機進行手術后,患者的恢復狀況以及并發(fā)癥情況�？偨Y兩組患者的平均住院費用和住院時間,并且進行對比。結果:(1)治療后1周,兩組患者的GCS平均評分無顯著性差異(P0.05),但是治療2周后兩組患者的GCS評分具有顯著性差異(P0.05)。(2)兩組患者在治療1周后NIHSS神經功能評分存在顯著性差異(P0.05)。且隨著治療后恢復的時間增加,兩組患者的神經功能評分的統(tǒng)計學差異越大。(3)主要并發(fā)癥有消化道出血、肺部感染、顱內感染、腎衰竭、心臟衰竭以及治療后顱內再次出血,微創(chuàng)組并發(fā)癥總發(fā)生率為25.93%,保守組并發(fā)癥總發(fā)生率為22.22%。經過統(tǒng)計學分析后發(fā)現(xiàn),顱內感染發(fā)生率微創(chuàng)組明顯高于保守組,具有統(tǒng)計學差異(p0.05),但兩組患者總的并發(fā)癥發(fā)生率不存在顯著性差異(P0.05)。(4)兩組患者的恢復情況存在顯著性差異(p0.05)。即微創(chuàng)組患者的恢復情況明顯優(yōu)于保守組,死亡率明顯低于保守組。(5)其中超早期與早期進行微創(chuàng)血腫清除術治療,患者恢復率不存在顯著性差異(P0.05),而超早期與延期,早期與延期治療,患者的恢復情況年均存在顯著性差異(P0.05)。(6)超早期、早期以及延期治療并發(fā)癥發(fā)生率均不存在統(tǒng)計學差異(P0.05)。(7)兩組患者的總花費,藥費以及住院時間均存在統(tǒng)計學差異(p0.05),但是兩組患者的治療費不存在統(tǒng)計學差異(P0.05)。結論:微創(chuàng)治療的GCS評分明顯優(yōu)于保守治療。治療4周后的神經系統(tǒng)評分也明顯優(yōu)于保守治療。微創(chuàng)治療的患者康復程度也優(yōu)于保守治療的患者。而且從經濟學角度來分析,微創(chuàng)治療也明顯強于保守治療,兩者總并發(fā)癥發(fā)生率相當。因此對于中等量高血壓腦出血患者應該選擇微創(chuàng)血腫清除術進行治療。
[Abstract]:Objective: to determine the treatment method and treatment period of moderate hypertensive intracerebral hemorrhage by analyzing the treatment method and the effect during the operation period of patients with moderate hypertensive intracerebral hemorrhage. Methods: 324 patients with moderate hypertensive intracerebral hemorrhage from 2012 to 2015 were selected retrospectively. There were 198 males and 126 females. The average age was (56 鹵3.8). All the patients in the study were divided into two groups: the minimally invasive treatment group and the drug treatment group. The minimally invasive group was treated with soft channel minimally invasive hematoma removal and the drug group with conservative therapy. GCS coma index and NIHSS neurological function were evaluated before treatment and 1 week, 2 weeks and 4 weeks after treatment. Four weeks after operation, the patients in the two groups were graded according to the activity of Daily living (activitiesdaily living,ADL) method, and the complications after treatment were compared between the two groups. To summarize the recovery and complications of patients in minimally invasive group. The average cost and duration of hospitalization were summarized and compared between the two groups. Results: (1) there was no significant difference in GCS scores between the two groups at 1 week after treatment (P0.05). However, the GCS scores of the two groups were significantly different after 2 weeks of treatment (P0.05). (2). There was a significant difference in the NIHSS neurological function score between the two groups after 1 week of treatment (P0.05). With the increase of recovery time after treatment, the statistical difference of neurological function score between the two groups was greater. (3) the main complications were gastrointestinal hemorrhage, pulmonary infection, intracranial infection, renal failure. The total incidence of complications was 25.93 in the minimally invasive group and 22.222 in the conservative group. The incidence of intracranial infection in the minimally invasive group was significantly higher than that in the conservative group (p0.05). However, there was no significant difference in the incidence of complications between the two groups (P0.05). (4). There was a significant difference in the recovery between the two groups (p0.05). That is, the recovery of the patients in the minimally invasive group was significantly better than that in the conservative group, and the mortality was significantly lower than that in the conservative group. (5) there was no significant difference in the recovery rate between the super early stage and the early stage of minimally invasive hematoma clearance (P0.05). However, there were significant differences in the average annual recovery between the patients with ultra-early and delayed treatment and treatment (P0.05). (6). There was no significant difference in the incidence of complications between the early and delayed treatment groups (P0.05). (7). The total cost, drug cost and hospitalization time of the two groups were significantly different (p0.05), and there was no significant difference in the incidence of complications between the two groups (p0.05). However, there was no statistical difference between the two groups (P0.05). Conclusion: the GCS score of minimally invasive therapy is better than that of conservative treatment. The nervous system score after 4 weeks of treatment was also significantly better than that of conservative treatment. The degree of rehabilitation of minimally invasive treatment was also superior to that of conservative treatment. From an economic point of view, minimally invasive treatment is also significantly stronger than conservative treatment, the total incidence of complications is the same. Therefore, minimally invasive hematoma clearance should be selected for patients with moderate hypertensive intracerebral hemorrhage.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.12
本文編號：2340212
[Abstract]:Objective: to determine the treatment method and treatment period of moderate hypertensive intracerebral hemorrhage by analyzing the treatment method and the effect during the operation period of patients with moderate hypertensive intracerebral hemorrhage. Methods: 324 patients with moderate hypertensive intracerebral hemorrhage from 2012 to 2015 were selected retrospectively. There were 198 males and 126 females. The average age was (56 鹵3.8). All the patients in the study were divided into two groups: the minimally invasive treatment group and the drug treatment group. The minimally invasive group was treated with soft channel minimally invasive hematoma removal and the drug group with conservative therapy. GCS coma index and NIHSS neurological function were evaluated before treatment and 1 week, 2 weeks and 4 weeks after treatment. Four weeks after operation, the patients in the two groups were graded according to the activity of Daily living (activitiesdaily living,ADL) method, and the complications after treatment were compared between the two groups. To summarize the recovery and complications of patients in minimally invasive group. The average cost and duration of hospitalization were summarized and compared between the two groups. Results: (1) there was no significant difference in GCS scores between the two groups at 1 week after treatment (P0.05). However, the GCS scores of the two groups were significantly different after 2 weeks of treatment (P0.05). (2). There was a significant difference in the NIHSS neurological function score between the two groups after 1 week of treatment (P0.05). With the increase of recovery time after treatment, the statistical difference of neurological function score between the two groups was greater. (3) the main complications were gastrointestinal hemorrhage, pulmonary infection, intracranial infection, renal failure. The total incidence of complications was 25.93 in the minimally invasive group and 22.222 in the conservative group. The incidence of intracranial infection in the minimally invasive group was significantly higher than that in the conservative group (p0.05). However, there was no significant difference in the incidence of complications between the two groups (P0.05). (4). There was a significant difference in the recovery between the two groups (p0.05). That is, the recovery of the patients in the minimally invasive group was significantly better than that in the conservative group, and the mortality was significantly lower than that in the conservative group. (5) there was no significant difference in the recovery rate between the super early stage and the early stage of minimally invasive hematoma clearance (P0.05). However, there were significant differences in the average annual recovery between the patients with ultra-early and delayed treatment and treatment (P0.05). (6). There was no significant difference in the incidence of complications between the early and delayed treatment groups (P0.05). (7). The total cost, drug cost and hospitalization time of the two groups were significantly different (p0.05), and there was no significant difference in the incidence of complications between the two groups (p0.05). However, there was no statistical difference between the two groups (P0.05). Conclusion: the GCS score of minimally invasive therapy is better than that of conservative treatment. The nervous system score after 4 weeks of treatment was also significantly better than that of conservative treatment. The degree of rehabilitation of minimally invasive treatment was also superior to that of conservative treatment. From an economic point of view, minimally invasive treatment is also significantly stronger than conservative treatment, the total incidence of complications is the same. Therefore, minimally invasive hematoma clearance should be selected for patients with moderate hypertensive intracerebral hemorrhage.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.12
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