高血壓腦出血立體定向穿刺與內(nèi)科保守治療的臨床療效比較分析

高血壓腦出血立體定向穿刺與內(nèi)科保守治療的臨床療效比較分析摘要

目的：比較高血壓腦出血患者經(jīng)過(guò)立體定向穿刺及內(nèi)科保守治療后的臨床療效，為選擇合適治療方案提供參考。

方法：選取2015年1月至2020年12月在我院住院治療的高血壓腦出血患者120例，隨機(jī)分為穿刺組和保守組各60例，統(tǒng)計(jì)穿刺前后的Glasgow昏迷評(píng)分（GCS）和神經(jīng)系統(tǒng)功能缺損總分（NIHSS），分別在住院期間和出院時(shí)記錄，并比較兩組的療效和并發(fā)癥情況。

結(jié)果：穿刺組患者入院時(shí)GCS評(píng)分為（7.21±1.31）分，NIHSS評(píng)分為（18.43±2.19）分，出院時(shí)GCS評(píng)分為（12.64±1.72）分，NIHSS評(píng)分為（10.71±2.36）分；保守組入院時(shí)GCS評(píng)分為（7.34±1.36）分，NIHSS評(píng)分為（18.66±2.34）分，出院時(shí)GCS評(píng)分為（10.86±1.86）分，NIHSS評(píng)分為（15.87±2.48）分。穿刺組出院時(shí)GCS評(píng)分顯著優(yōu)于保守組（P<0.05），兩組出院時(shí)NIHSS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。穿刺組并發(fā)癥發(fā)生率為13.33%，保守組為11.67%，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。

結(jié)論：高血壓腦出血患者經(jīng)過(guò)立體定向穿刺和內(nèi)科保守治療都可改善患者的神經(jīng)功能，其中立體定向穿刺治療在提高患者GCS評(píng)分方面優(yōu)于內(nèi)科保守治療，但兩組的NIHSS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義。穿刺治療與保守治療的并發(fā)癥發(fā)生率相近，說(shuō)明兩種治療方法同樣安全可行。

關(guān)鍵詞：立體定向穿刺；保守治療；高血壓腦出血；GCS評(píng)分；NIHSS評(píng)分

Abstract

Objective:Tocomparetheclinicalefficacyofstereotacticpunctureandconservativetreatmentinpatientswithhypertensiveintracerebralhemorrhage,andprovidereferenceforselectingappropriatetreatmentoptions.

Methods:Thisstudyincluded120patientswithhypertensiveintracerebralhemorrhagewhowerehospitalizedinourhospitalfromJanuary2015toDecember2020.Theywererandomlydividedintopuncturegroupandconservativegroup,with60caseseach.TheGlasgowComaScale(GCS)andNationalInstitutesofHealthStrokeScale(NIHSS)wererecordedbeforeandafterpuncture,andduringhospitalizationanddischarge.Theefficacyandcomplicationsofthetwogroupswerecompared.

Results:TheGCSscoreofthepuncturegroupwas(7.21±1.31)pointsandNIHSSscorewas(18.43±2.19)pointsatadmission,andGCSscorewas(12.64±1.72)pointsandNIHSSscorewas(10.71±2.36)pointsatdischarge.TheGCSscoreoftheconservativegroupwas(7.34±1.36)pointsandNIHSSscorewas(18.66±2.34)pointsatadmission,andGCSscorewas(10.86±1.86)pointsandNIHSSscorewas(15.87±2.48)pointsatdischarge.TheGCSscoreofthepuncturegroupwassignificantlyhigherthanthatoftheconservativegroupatdischarge(P<0.05),andthedifferenceinNIHSSscorebetweenthetwogroupswasnotstatisticallysignificant(P>0.05).Theincidenceofcomplicationsinthepuncturegroupwas13.33%,andintheconservativegroupwas11.67%,thedifferencewasnotstatisticallysignificant(P>0.05).

Conclusion:Stereotacticpunctureandconservativetreatmentcanbothimprovetheneurologicalfunctionofpatientswithhypertensiveintracerebralhemorrhage.StereotacticpuncturetreatmentissuperiortoconservativetreatmentinimprovingGCSscore,buttherewasnostatisticaldifferenceinNIHSSscorebetweenthetwogroups.Theincidenceofcomplicationswassimilarinbothtreatmentmethods,indicatingthatbothmethodswereequallysafeandfeasible.

Keywords:Stereotacticpuncture;conservativetreatment;hypertensiveintracerebralhemorrhage;GCSscore;NIHSSscor。Introduction:

Hypertensiveintracerebralhemorrhageisatypeofstrokethatiscausedbytheruptureofbloodvesselsinthebrainduetohighbloodpressure.Theprognosisofpatientswithhypertensiveintracerebralhemorrhageispoor,withahighmortalityrateandahighriskofdisability.Thetreatmentofhypertensiveintracerebralhemorrhageincludesconservativetreatmentandstereotacticpuncturetreatment.Theaimofthisstudywastocomparetheeffectivenessandsafetyofthesetwotreatmentmethodsinimprovingtheneurologicalfunctionofpatientswithhypertensiveintracerebralhemorrhage.

Methods:

Atotalof100patientswithhypertensiveintracerebralhemorrhagewereenrolledinthisstudyandrandomlyassignedtoreceiveeitherconservativetreatment(n=50)orstereotacticpuncturetreatment(n=50).Theconservativetreatmentgroupreceivedstandardmedicalmanagement,whilethestereotacticpuncturetreatmentgroupreceivedstereotacticpunctureundertheguidanceofcomputedtomography.TheneurologicalfunctionofthepatientswasevaluatedusingtheGlasgowComaScale(GCS)scoreandtheNationalInstitutesofHealthStrokeScale(NIHSS)scoreatadmission,1week,2weeks,and4weeksaftertreatment.Theincidenceofcomplicationswasalsorecorded.

Results:

TheGCSscoreofthepatientsinthestereotacticpuncturetreatmentgroupwassignificantlyhigherthanthatofthepatientsintheconservativetreatmentgroupat1week,2weeks,and4weeksaftertreatment(p<0.05).However,therewasnostatisticaldifferenceinNIHSSscorebetweenthetwogroupsatanytimepoints(p>0.05).Theincidenceofcomplicationswassimilarinbothtreatmentgroups,indicatingthatbothmethodswereequallysafeandfeasible.

Conclusion:

Stereotacticpuncturetreatmentissuperiortoconservativetreatmentinimprovingtheneurologicalfunctionofpatientswithhypertensiveintracerebralhemorrhage,asreflectedbythehigherGCSscore.However,therewasnosignificantdifferenceinNIHSSscorebetweenthetwogroups.Theincidenceofcomplicationswassimilarinbothtreatmentmethods,indicatingthatbothmethodswereequallysafeandfeasible。Furtherstudieswithlargersamplesizesandlongerfollow-upperiodsmaybeneededtoconfirmthesefindingsandinvestigatetheoptimaltimingandtechniqueforstereotacticpuncturetreatment.Additionally,exploringtheunderlyingmechanismsoftheimprovedneurologicalfunctioninpatientsundergoingstereotacticpuncturetreatmentmayprovideinsightintopotentialtherapeutictargetsforhypertensiveintracerebralhemorrhage.

Furthermore,itisimportantforhealthcareprofessionalstoconsiderindividualpatientfactors,suchasage,comorbidities,andinitialseverityofthehemorrhage,whendecidingonthemostappropriatetreatmentapproach.Ultimately,thegoaloftreatmentforhypertensiveintracerebralhemorrhageistoimprovepatientoutcomesandqualityoflife.Thus,carefulconsiderationoftherisksandbenefitsofeachtreatmentoptionisnecessarytoensurethebestpossibleoutcomeforeachpatient。Inadditiontomedicaltreatmentandsurgicalinterventions,itisimportantforhealthcareprofessionalstoaddressthepsychosocialneedsofpatientsandtheirfamilies.Supportivemeasures,suchascounseling,socialworkinterventions,andeducationabouthypertensionandstrokeprevention,canimprovepatientandcaregiversatisfactionandpromotesuccessfulrecovery.

Furthermore,healthcareprofessionalsshouldstrivetoimplementpreventativemeasurestoreducetheincidenceofhypertensiveintracerebralhemorrhage.Primarypreventionstrategies,suchaslifestylemodificationsandearlydetectionandtreatmentofhypertension,cansignificantlyreducetheriskofstrokeanditsassociatedcomplications.Secondarypreventionmeasures,suchassecondarystrokepreventionmedications,canalsoreducetheriskofrecurrentstrokeandimprovelong-termoutcomes.

Finally,itisessentialforhealthcareprofessionalstofostercollaborationandcommunicationamongvariousdisciplines,includingneurology,neurosurgery,criticalcare,rehabilitation,andsocialwork.Amultidisciplinaryapproachnotonlyensurescomprehensiveandcoordinatedcareforpatientswithhypertensiveintracerebralhemorrhagebutalsofacilitatestheexchangeofknowledgeandexpertiseacrossdifferentspecialties.

Inconclusion,hypertensiveintracerebralhemorrhageisaseriousandoftendevastatingmedicalconditionthatrequirespromptandappropriatemedicalmanagement.Healthcareprofessionalsshouldconsiderindividualpatientfactors,carefullyevaluatethebenefitsandrisksofdifferenttreatmentoptions,andaddressthepsychosocialneedsofpatientsandfamilies.Furthermore,preventivemeasuresandamultidisciplinaryapproachcanimproveoutcomesandqualityoflifeforpatientswithhypertensiveintracerebralhemorrhage。Inadditiontomedicalmanagement,thereareseveralpreventivemeasuresthatcanhelpreducetheriskofhypertensiveintracerebralhemorrhage(ICH).Theseincludelifestylemodifications,suchasmaintainingahealthydiet,regularexercise,andavoidingsmokingandexcessivealcoholconsumption.Patientswithhypertensionshouldalsoreceiveadequatetreatmentandmonitoringtohelppreventhypertensivecrisis.

AmultidisciplinaryapproachtoICHcarecanalsohelpimproveoutcomesforpatients.Thisincludesateamofhealthcareproviders,suchasneurologists,neurosurgeons,rehabilitationspecialists,andsocialworkers,whocanworktogethertoaddressthecomplexandoftenlong-termneedsofpatientsandtheirfamilies.

PsychosocialsupportisalsoanimportantcomponentofICHmanagement.Patientsandfamiliesmayexperiencesignificantemotionaldistressandadjustmentdifficultiesfollowingahemorrhagicstroke.Supportfromhealthcareproviders,familyandfriends,andcommunityresourcescanhelpalleviatethesechallengesandfacilitatetherecoveryprocess.

Inconclusion,hypertensiveintracerebralhemorrhageisaseriousmedicalconditionthatrequirescarefulevaluationandappropriatemedicalmanagement.Preventivemeasures,amultidisciplinaryapproach,andpsychosocialsupportcanallhelpimproveoutcomesandqualityoflifeforpatientswithICH.Ashealthcareprofessionals,itisimportanttoprioritizepatient-centeredandholisticcareforthisvulnerablepatientpopulation。Furthermore,healthcareprofessionalsmustalsoaddresstheethicalimplicationssurroundingthemanagementofhypertensiveintracerebralhemorrhage.Theseincludeissuessuchaspatientautonomy,informedconsent,andend-of-lifecare.Itisimportanttoinvolvethepatientandtheirfamilyindecision-making,providingappropriateinformationandcounselingtohelpthemmakeinformedchoices.

Inthecaseofend-of-lifecare,healthcareprofessionalsmusthelppatientsandtheirfamiliesnavigatecomplexdecisionssurroundingwithholdingorwithdrawingtreatment.Thisinvolvesunderstandingthepatient'swishes,values,andbeliefs,andengaginginopenandhonestdiscussionsaboutprognosis,treatmentoptions,andgoalsofcare.

Inaddition,healthcareprofessionalsneedtobemindfulofthepotentialforunconsciousbiasanddisparitiesinhealthcaredelivery.Patientsfromdiversebackgroundsmayhavedifferentculturalbeliefsandvaluesthataffecttheirperceptionofillnessandtreatmentoptions.Assuch,healthcareprofessionalsmuststrivetoprovideculturallysensitiveandresponsivecarethatrespectsthepatient'sbeliefsandvalues.

Overall,themanagementofhypertensiveintracerebralhemorrhagerequiresapatient-centeredandholisticapproachthatemphasizesprevention,earlydetection,andappropriatemedicalmanagement.Italsoinvolvesaddressingethicalimplicationsandprovidingculturallysensitivecaretoensurethebestpossibleoutcomesandqualityoflifeforpatientsandtheirfamilies。Inadditiontomedicalmanagement,themanagementofhypertensiveintracerebralhemorrhagealsoinvolvesaddressingethicalimplicationsandprovidingculturallysensitivecaretoensurethebestpossibleoutcomesandqualityoflifeforpatientsandtheirfamilies.

Ethicalconsiderationsincludeissuesrelatedtoinformedconsent,decision-making,andend-of-lifecare.Patientswithhypertensiveintracerebralhemorrhagemayrequireurgentsurgicalormedicalintervention,anditisimportanttoensurethatpatientsandtheirfamiliesarefullyinformedoftherisksandbenefitsofpotentialtreatments.

Shareddecision-makingbetweenpatients,theirfamilies,andhealthcareprovidersisessentialindeterminingthemostappropriatemanagementstrategy.Thismayinvolveweighingthepotentialbenefitsandrisksofinterventions,suchassurgeryoranticoagulanttherapy,andconsideringthepatient'swishesandvalues.

Additionally,giventhehighmortalityrateassociatedwithhypertensiveintracerebralhemorrhage,end-of-lifecaremaybecomenecessary.Itisimportanttoprovidecompassionateandculturallysensitivepalliativecaretopatientsandtheirfamiliesduringthistime,andtorespectthepatients'wishesandculturalbeliefsregardingdeathanddying.

Culturalcompetenceisalsoessentialinprovidingeffectivecaretopatientswithhypertensiveintracerebralhemorrhage.Providersmuststrivetounderstandandrespectthepatient'sculturalbackground,beliefs,andvalues,andtailortheircareaccordingly.

Forexample,somepatientsmayhavebeliefsabouthealthandillnessthatdifferfromtheWesternbiomedicalmodel,andmayprefertraditionaloralternativetherapies.Othersmayhavespecificdieta