不同手术时机治疗高血压性脑出血的研究现状及进展

Research Status and Progress of Different Surgical Timing in the Treatment of Hypertensive Intracerebral Hemorrhage

摘要: 高血压性脑出血(HICH)作为全球范围内常见的脑血管疾病，其高致残率与高死亡率给患者及其家庭带来了沉重的负担。传统内科保守治疗虽能在一定程度上控制病情，却难以有效清除血肿，致使患者预后欠佳。故而，外科手术治疗成为HICH的重要手段之一。近些年来，伴随医疗技术的持续进步，超早期与早期外科手术治疗HICH能够显著提升患者的生存率和生活质量，并减少并发症的发生，逐渐受到关注。本文着眼于高血压性脑出血(HICH)的手术治疗时机问题，梳理了近期的研究现状及进展，剖析了多项对比不同手术时机，如超早期(发病至手术时间 < 6 h)及早期(发病至手术时间6~24 h)手术对高血压性脑出血患者预后和治疗效果的影响。这些研究表明，超早期手术能显著提高患者的生存率和生活质量，但较早期手术再出血风险较高。而且对于中等量基底节区出血的患者，微创手术或许是一种有效的手段。尽管已取得一定进展，但手术时机的最佳选择仍需进一步的临床研究支持。综合这些研究成果，为临床实践中手术时机的决策提供科学依据。

Abstract: Hypertensive intracerebral hemorrhage (HICH) is a common cerebrovascular disease worldwide. Its high disability rate and high mortality rate have brought a heavy burden to patients and their families. Although traditional medical conservative treatment can control the disease to a certain extent, it is difficult to effectively remove the hematoma, resulting in poor prognosis for patients. Therefore, surgical treatment has become one of the important means of HICH. In recent years, with the continuous progress of medical technology, ultra-early and early surgical treatment of HICH can significantly improve the survival rate and quality of life of patients and reduce the incidence of complications, which has gradually gained attention. This article focuses on the timing of surgical treatment of hypertensive intracerebral hemorrhage (HICH), sorts out the current status and progress of recent research, and analyzes the effect of several comparisons of different surgical timings, such as ultra-early (time from onset to operation < 6 h) and early (time from onset to operation 6~24 h), on the prognosis and treatment of patients with hypertensive intracerebral hemorrhage. These studies have shown that ultra-early surgery can significantly improve the survival rate and quality of life of patients, but the risk of rebleeding is higher than that of early surgery. Moreover, for patients with moderate basal ganglia hemorrhage, minimally invasive surgery may be an effective method. Although some progress has been made, the best choice of surgical timing still needs further clinical research support. Combining these research results, it provides a scientific basis for the decision-making of surgical timing in clinical practice.