【作者】 宋春旺；

【导师】 程远；

【作者基本信息】 重庆医科大学 ， 外科学， 2011， 硕士

【摘要】 目的探讨手术干预对高血压脑出血后血肿周围脑水肿形成与发展的影响。方法选择高血压脑出血患者160例,根据其入院后治疗方式分保守组、开颅组和微创组。采用相关性分析研究入选病例入院时血肿量和入院时水肿量的相关性;保守组以患者的年龄、性别、入院收缩压、舒张压、血肿量、血肿部位、GCS、Fib和血糖为自变量,分别以入院后第1天、第3天、第7天、第14天脑水肿相对增量(relative growth of perihematomal edema volume,RE)为因变量分别采用简单线性和多元线性回归分析研究相关性;保守组中不同出血部位对第1、3、7、14天RE的影响采用方差分析研究;保守组中不同出血部位不同血肿量对第1、3、7、14天RE的影响采用方差分析研究;幕上出血微创术、开颅术和保守治疗三者间及幕下出血开颅术与保守治疗间对RE在第1-3,3-7,7-14和14-21天的影响采用方差分析研究。结果高血压脑出血后血肿量与脑水肿发生呈正相关(R2=0.5831),与不同时间点脑水肿相对增量相关(P <0. 01);不同出血部位的RE间无统计学差异(P>0.05)。幕上小血肿的RE最大(P<0.05);幕上微创组和开颅组间的RE无明显差异(P>0.05),与保守组相比,RE较少(P<0.05);幕下开颅组与保守组相比,RE无明显差异(P>0.05)。结论高血压脑出血后血肿量与脑水肿程度、RE密切相关,幕上小量血肿对脑水肿变化速率影响较大,手术治疗在一定程度上减轻脑水肿发展速率。更多还原

【Abstract】 Objective To investigate the effect of Surgical intervention on brain edema formation and development after Hypertensive Intracerebral Hemorrhage (HICH).Methods 160 patients with HICH were divided into conservative group(C group) and surgery group which includes craniotomy group(Sc group) and minimally invasive group(Sm group) . We evaluated the association between baseline hematoma and edema by simple linear regression model. For the conservative group, age, sex, SBP, DBP, GCS, Fib,baseline hematoma, location and blood glucose were independent variable, while the relative growth of perihematomal edema volume(RE) at different time points were dependent variable, all the independent variables were evaluated by simple linear regression except location and multiple linear regression model, respectively; Analysis of variance were used with different bleeding sites, the different classifications of the hematoma volume, surgical and non-surgical, surgery in different ways, different parts of the operation was on the relative growth of perihematomal edema volume. Results There was a highly significant correlation between hematoma an d perihematomal edema volumes at baseline( R2 =0.5831) ,and between hematoma and RE at different time(P<0.01); there was no significant statistic difference between RE of different bleeding sites(P>0.05).A small quantity of supratentorial intracerebral hematoma impact largest on RE(P<0.05); There was no significant difference between RE of Sc group and Sm group, but they were significantly lower as compared with C group(P<0.05).There was no significantly difference between RE of C group and Sc group with infratentorial intracerebral Hemorrhage (P>0.05).Conclusions The degree of perihematomal edema and RE are strongly related to the size of the baseline hematoma of HICH; A small quantity of supratentorial hematoma impacts largely on the development of brain edema; Removing hematoma by surgery can reduce the development of brain edema.更多还原