[1]陳軍 李愛民 吳海濱 顏士衛(wèi) 陳覃 司憲平 施輝 王富元 江偉 劉希光 孫維曄

　　摘要：目的 研究高血壓腦出血最佳手術(shù)時(shí)機(jī)。方法 1000例高血壓性腦出血，內(nèi)科組507例，外科組493例。按發(fā)病-治療時(shí)間分為：超早期組(≤7h)，早期組(7～24h)和晚期組(＞24h)共3 組，分別進(jìn)行內(nèi)、外科療效比較和組間外科療效比較。療效判定指標(biāo)為：近期療效、遠(yuǎn)期療效、病死率、優(yōu)良率和并發(fā)癥發(fā)生率等。結(jié)果 (1) 超早期組和早期組，手術(shù)療效優(yōu)于內(nèi)科治療；(2) 超早期組和早期組，手術(shù)療效無顯著差異；（3）超早期組術(shù)后顱內(nèi)再出血風(fēng)險(xiǎn)高，早期組再出血率下降；（4）晚期組，外科組的呼吸、泌尿和消化系統(tǒng)并發(fā)癥發(fā)生率高于內(nèi)科組。結(jié)論 高血壓腦出血發(fā)病后早期（7～24h），是最佳手術(shù)時(shí)機(jī)。連云港市第一人民醫(yī)院神經(jīng)外科陳軍

　　關(guān)鍵詞：腦出血；高血壓；手術(shù)；時(shí)間

　　The optimization of time course for surgical treatment of hypertensive intracerebral hemorrhage CHEN Jun, LI Aimin, WU Haibin, etal. Department of Neurosurgery,Lianyungang First Hosipital,Xuzhou Medical College, Lianyungang 222002,Jiangsu,China

　　Abstract: Objective To determine the optimal time course for surgical treatment of hypertensive intracerebral hemorrhage(ICH). Methods Among all 1000 cases of  ICH, there were 507 cases for medical treatment and 493 cases for surgical treatment. According to the time course after imitial onset, they were divided into three groups, which were Ultra-early group(≤7h)，early group(7~24h), and Delay group(＞24h). The near-term outcome (GOS scale), lon-term outcome(Barthel scale), mortality, as well as incidence of associated complications were compared respectively. Results (1) In the Ultra-early group and early group, both the near-term and lon-term outcome of surgical treatment was definitely better than medical treatment. (2) For the outcome of surgical treatment, there was no significantly difference between Ultra-early and early groups.(3) In the Ultra-early group,the risk of recurrent post-operative hemorrage was higher,and decreased benceforth. (4) In the Delay group,the incidence of associated complications of respiratory,urinary and gastrointestinal system was higher for surgery than medication.Conclusion The early stage (7~24h) was the optimal time course for surgical treatment of intracerebral hemorrhage.

　　Key words: cerebral hemorrhage; hypertention;surgery; time facts

　　[1]作者單位：徐州醫(yī)學(xué)院附屬連云港醫(yī)院神經(jīng)外科 連云港市222002  通訊作者: 陳軍Correspondence to: Jun Chen    Tel: 13605132290; E-mail:junchen63@yahoo.com.cn