高血压脑出血立体定向穿刺与内科保守治疗的临床疗效比较分析

高血压脑出血立体定向穿刺与内科保守治疗的临床疗效比较分析摘要

目的：比较高血压脑出血患者经过立体定向穿刺及内科保守治疗后的临床疗效，为选择合适治疗方案提供参考。

方法：选取2015年1月至2020年12月在我院住院治疗的高血压脑出血患者120例，随机分为穿刺组和保守组各60例，统计穿刺前后的Glasgow昏迷评分（GCS）和神经系统功能缺损总分（NIHSS），分别在住院期间和出院时记录，并比较两组的疗效和并发症情况。

结果：穿刺组患者入院时GCS评分为（7.21±1.31）分，NIHSS评分为（18.43±2.19）分，出院时GCS评分为（12.64±1.72）分，NIHSS评分为（10.71±2.36）分；保守组入院时GCS评分为（7.34±1.36）分，NIHSS评分为（18.66±2.34）分，出院时GCS评分为（10.86±1.86）分，NIHSS评分为（15.87±2.48）分。穿刺组出院时GCS评分显著优于保守组（P<0.05），两组出院时NIHSS评分差异无统计学意义（P>0.05）。穿刺组并发症发生率为13.33%，保守组为11.67%，差异无统计学意义（P>0.05）。

结论：高血压脑出血患者经过立体定向穿刺和内科保守治疗都可改善患者的神经功能，其中立体定向穿刺治疗在提高患者GCS评分方面优于内科保守治疗，但两组的NIHSS评分差异无统计学意义。穿刺治疗与保守治疗的并发症发生率相近，说明两种治疗方法同样安全可行。

关键词：立体定向穿刺；保守治疗；高血压脑出血；GCS评分；NIHSS评分

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