Observation on the short-term prognosis of surgical treatment for hypertensive cerebral hemorrhage
高血压脑出血手术治疗近期预后的疗效观察

摘要

目的 本研究观察高血压脑出血手术近期疗效及预后，分析影响短期预后的因素，为优化手术方案和改善预后提供参考。方法 选取2021年1月至2024年12月我院收治的86例高血压脑出血手术患者，收集患者资料与手术数据，记录术后并发症和1、3个月神经功能恢复情况。根据术后3个月改良Rankin量表（mRS）评分将患者分为预后良好组与不良组，分析手术疗效、并发症及预后影响因素。结果 手术全部成功。术后血肿完全清除79例，清除率91.86%。近期并发症发生率18.60%，主要为肺部与颅内感染。术后1个月、3个月的国立卫生院中风量表（NIHSS）评分显著降低，Barthel指数显著升高（P<0.05）。术后3个月预后良好率67.44%。单因素分析显示，年龄、血肿量、出血部位、术前NIHSS评分、是否破入脑室及术后并发症是影响预后的相关因素（P<0.05）。结论 手术治疗高血压脑出血可有效清除血肿并改善神经功能，近期疗效确切。高龄、血肿大、深部出血等是高危因素，需临床干预改善短期预后。

Abstract

Objective This study observed the short-term efficacy and prognosis of surgical treatment for hypertensive cerebral hemorrhage, analyzed the factors influencing short-term prognosis, and provided references for optimizing surgical plans and improving prognosis.
Methods A total of 86 patients with hypertensive cerebral hemorrhage who were treated in our hospital from January 2021 to December 2024 were selected. Patient data and surgical data were collected, and postoperative complications and neurological function recovery at 1 and 3 months were recorded. According to the 3-month modified Rankin Scale (mRS) score, patients were divided into good prognosis group and poor prognosis group, and the surgical efficacy, complications, and prognostic influencing factors were analyzed.
Results All surgeries were successful. 79 cases had complete removal of hematoma, with a clearance rate of 91.86%. The incidence of short-term complications was 18.60%, mainly including pulmonary and intracranial infections. The National Institutes of Health Stroke Scale (NIHSS) scores at 1 month and 3 months after surgery significantly decreased, and the Barthel index significantly increased (P<0.05). The good prognosis rate at 3 months after surgery was 67.44%. Univariate analysis showed that age, hematoma volume, bleeding location, preoperative NIHSS score, whether the hematoma broke into the ventricle, and postoperative complications were related factors affecting prognosis (P<0.05).
Conclusion   Surgical treatment for hypertensive cerebral hemorrhage can effectively remove hematoma and improve neurological function, with definite short-term efficacy. Advanced age, large hematoma, deep bleeding, etc. are high-risk factors, and clinical intervention is needed to improve short-term prognosis.