CT导向穿刺治疗高血压脑出血

CT-Guidied Transhead Puncture Trentment for Hypertension Cerebral Hemorrhage

目的 :探讨定向穿刺术治疗高血压脑出血的方法和疗效。材料和方法 :通过CT导引定向穿刺治疗高血压脑出血患者 88例。男 5 0例 ,女 3 8例。年龄 3 6～ 83岁 ,平均 62 4岁。发病 6～ 12h手术 2 6例 ,12h以上手术 62例 ;3 0例单纯抽吸 ;2 0例溶凝后抽吸 ;3 8例溶凝 +碎吸清除。结果 :术后 1个月内有效 80例 (90 9% ) ,并发症共 15例 (17 5 % ) (其中 7例术前即已发生 ) ;重残 11例 (12 5 % ) (早期手术 1例 ,延期 10例 ) ;死亡 8例 (9 1% ) (早期 2例 ,近期 6例 )。经 3个月至2年对 73例随访 ,ADL1～ADL3 67例 (91 8% )。结论 :定向穿刺术治疗高血压脑出血优于内、外科治疗 ;发病 6～ 12h手术可明显降低死亡率和重残率。预防再次脑出血的关键是血肿的一次排出量和排空速度分别在 5 0 %～ 80 %和 2ml/min 。

Purpose: To investigate the clinical effects and treating methods for orientating puncture therapy hypertension cerebral hemorrhage by CT guidied. Materials and methods: 88 patients with hypertension cerebral hemorrhage (female 38, male 50, range of age 36 to 83, mean age 62.4yr) had treated included operation at 6～12 hours after attack of the disease in 26, >12 hours in 62; CT gnided aspiration in 30, the hematoma which had solvated with chmical agents before aspiration in 20 and aspiration after having broken the hematoma with machine then solvated them with chemicalagents in 38. Results: A month after the operation the clinical effects of 80 patients were available (90.9%); 15 patients occured complication (17.5%) (7 of them occured before aperations); 11 of them became serious disablitities (12/5%); 8 patients died. In follow up of 3 months to 2 years for 73 patients, we found 67 (91.8%) of them had ADL 1～ADL 3. Conclusion: The orienting puncture treat hypertension cerebral hemorrhage is better than interal medicine or surgical operations. If the patients are received operations during 6～12h after the disease attack. Using this method can decrease therates of deaths and serious disablitites. But the main problem is to prevent the patients from second cerebral hemorrhage, we suggest that the draining quantity and speed of the hematoma must be 50～80% and 2ml/min once, respectirely. The key causes of deaths are intraventricular hematoma and complications.