The influence of emergency time factors on prognosis of patients with spontaneous intracerebral hemorrhage
自发性脑出血患者急救环节时间因素对预后的影响

摘要

目的 探讨自发性脑出血患者急救环节时间因素对预后的影响。方法 将自发性脑出血量为40～70ml的67例患者根据发病时间、是否进入绿色通道分为研究组和对照组，研究组30例，对照组37例。研究组纳入发病后6小时内到院并启动脑卒中绿色通道的患者；对照组纳入发病后6小时外到院未启动脑卒中绿色通道的患者。两组患者均进行了脑立体定向微创穿刺颅内血肿清除术，术后监测并调控颅内压。分别将两组患者的院前急救时间环节、院内急救时间环节、术后颅内压值、神经功能缺损评分、术后生存情况进行比较。结果 2组自发性脑出血患者院前急救时间环节上存在差异，研究组卒中识别时间为（2.07±0.93）小时，和对照组卒中识别时间（24.38±7.72）小时比较，差异有统计学意义（P<0.05），研究组院前转运时间为（1.57±0.68）小时，和对照组（2.49±0.77）小时比较，差异有统计学意义（P<0.05）；2组自发性脑出血患者院内急救时间环节上存在差异，研究组接诊至开始CT检查时间为（14.83±2.67） min，和对照组（27.03±6.50） min比较，差异有统计学意义（P<0.05），研究组到病房至同意手术时间为（1.37±0.57）小时，和对照组（2.81±0.58）小时比较，差异有统计学意义（P<0.05），研究组同意到穿刺时间为（1.33±0.33）小时，和对照组（2.88±0.73）小时比较，差异有统计学意义（P<0.05）；带引流管的ICP传感器探头能较好地检测及调节颅内压，在引流管通畅的情况下，颅内压值控制在15mmHg左右，波动较小；术后第三、四天研究组颅内压值逐步降低，和对照组比较差异有统计学意义（P<0.05）；研究组入院后1周和2周神经功能缺损评分和对照组比较差异均有统计学意义（P<0.05）；急救环节时间较短的研究组自发性脑出血患者第3个月、第6个月生存率增加，和对照组比较，差异有统计学意义（P<0.05）。结论 院前、院内各个急救时间环节对脑出血的预后有一定的影响，急救环节时间较短的自发性脑出血患者，术后颅内压较低，大脑的损害程度较轻，预后较好。

Abstract

Objective: To investigate the influence of emergency time factors on prognosis of patients with spontaneous intracerebral hemorrhage.
Methods: Sixty-seven patients with spontaneous intracerebral hemorrhage of 40-70ml were divided into study group and control group according to the onset time and whether they entered the green channel. There were 30 patients in study group and 37 patients in control group. The study group included patients who arrived at the hospital within 6 hours of onset and activated the stroke green channel, the control group included patients who arrived at the hospita 6 hours after onset and did not activate stroke green channel. Patients in both groups underwent intracranial hematoma removal by stereotactic minimally invasive puncture, and the intracranial pressure was monitored and regulated after surgery. The time factors of pre-hospital emergency care, time factors of in-the hospital emergency care, the postoperative intracranial pressure value, the neurological function deficit score and the postoperative survival of the two groups were compared respectively.
Results: There were differences in the time factors of pre-hospital emergency care between the two groups of patients with spontaneous cerebral hemorrhage, the stroke recognition time of the study group was (2.07 ±0.93) hours, compared with the control group (24.38±7.72) hours, the difference was statistically significant (P<0.05),the pre-hospital transport time of the study group was (1.57±0.68) hours, compared with the control group (2.49±0.77) hours, the difference was statistically significant (P<0.05).There were differences in the time factors of in-the hospital emergency care between the two groups of patients with spontaneous cerebral hemorrhage, the time from receiving to starting CT examination in the study group was (14.83±2.67) min, compared with the control group (27.03±6.50) min, the difference was statistically significant (P<0.05), the time of the study group from arriving the hospital ward to the agreeing surgery was (1.37±0.57) hours, compared with the control group (2.81±0.58) hours, the difference was statistically significant (P<0.05), the time of the study group from agreement to puncture was (1.33±0.33) hours, compared with the control group (2.88±0.73) hours, the difference was statistically significant (P<0.05).ICP sensor probe with drainage tube can better detect and regulate intracranial pressure, under the condition that the drainage tube is unblocked, the intracranial pressure is controlled at about 15mmHg, it fluctuates a little. On the third and fourth day after surgery, intracranial pressure in the study group decreased gradually, and the difference was statistically significant compared with the control group (P<0.05).There were statistically significant differences in neurological deficit scores between the study group and the control group at 1 and 2 weeks after admission (P<0.05).The survival rate of patients with spontaneous intracerebral hemorrhage in the study group with short emergency care time factors increased at the 3rd and 6th month, and the difference was statistically significant compared with the control group (P<0.05).
Conclusion  : The prognosis of intracerebral hemorrhage is positively influenced by the time facrors of pre-hospital emergency care and in-the hospital emergency care, the patients with spontaneous intracerebral hemorrhage who received short emergency care time factors had lower postoperative intracranial pressure, lighter brain damage and better prognosis.