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目的颅内血肿体积在临床上可作为高血压性脑出血(ICH)急性期治疗方法选择和预后评价的重要参考指标,探讨非手术治疗和手术治疗对ICH早期预后的影响。方法回顾性分析291例幕上和幕下小脑出血患者的病史、临床指标和CT影像学资料。根据公式1/2ABC测量血肿的出血量,收集患者的美国国立卫生研究院卒中评分(NIHSS)、格拉斯哥昏迷评分(GCS)和国际颅内出血外科治疗试验应用的预后评估(STICH预后评估)评分结果,评价患者术后的早期预后。2P1例ICH患者中220例未行手术治疗(非手术治疗组),71例行手术治疗(手术治疗组)。应用STICH预后评估评分将所有病例分为预后良好(评分≥27.672分)和预后不良(评分<27.672分)。结果预后良好的ICH患者行早期手术治疗后的效果并不明显,与非手术治疗组相似(P=0.726);但预后不良中,早期进行手术治疗比非手术治疗患者或有一定的获益(P=0.004)。结论 STICH预后评估评分是一种简单有效的评估工具,根据评分有可能提示对预后不良的ICH患者采用手术治疗方案可更好地挽救患者生命,有利于早期神经功能的恢复。
Objective The volume of intracranial hematoma can be clinically used as an important reference index in the treatment of acute intracerebral hemorrhage (ICH) in acute stage and evaluation of prognosis, and to explore the influence of non-surgical treatment and surgical treatment on the early prognosis of ICH. Methods A retrospective analysis of 291 patients with supratentorial and supratentorial cerebellar hemorrhage in patients with history, clinical indicators and CT imaging data. Hematoma bleeding was measured according to the formula 1/2 ABC, and the patient’s NIHSS, Glasgow coma score (GCS) and prognostic assessment (STICH prognosis assessment) score of the International Intracranial Hemorrhage Surgical Treatment Trial were collected, Evaluation of patients with early prognosis. Of the 2P1 patients with ICH, 220 were not surgically treated (nonsurgical group) and 71 were surgically treated (surgically treated group). All patients were classified as good prognosis (score ≥27.672) and poor prognosis (score <27.672) using STICH prognostic assessment score. Results The ICH patients with good prognosis had no obvious effect after early surgery, which was similar to the non-surgical treatment group (P = 0.726). However, in the unfavorable prognosis, the surgical treatment in the early stage was more effective than the non-surgical treatment P = 0.004). Conclusion The STICH prognostic assessment score is a simple and effective assessment tool. According to the scores, it is possible to suggest that the surgical treatment of ICH patients with poor prognosis may save the lives of patients better, which is good for the recovery of early neurological function.