高血压脑出血内外科治疗的死因对照分析

Causes of death of hypertensive cerebral hemorrhagetreated conservatively and surgically:A comparativeanalysis

对３５７例高皿压脑出血患者手术和保守治疗的死因进行对比分析。结果：意识状态对病死率有很大影响，清醒者手术组和保守组病死率分别为１１．０％、５．６０％；嗜睡～浅昏迷者两组病死率分别为３２．０％、６２．５％；中度昏迷者两组病死率分别为６３．０％、１００．０％；深昏迷者两组病死率分别为８５．０％、１００．０％。手术组和保守组肺部感染者的病死率分别为５２．３％、７２．７％；消化道出血者两组病死率分别为４３％、６６．６％；脑疝两组病死率分别为５４石％、７５．０％。二次手术和保守组再出血的病死率分别为４０．０％、１００．０％。从而表明，除清醒者外，手术可降低病死率。小脑、皮质下、基底节、脑室出血者手术疗效好、病死率低，基底节出血量＞３０ｍ１者病死宰低于保守组。

Comparative analyses were done in 357 patientswith hypertensive cerebral hemorrhage treatedconservatively and surgically。Status of consciousnesshad obvious effects on the mortality. The mortalityrate was11%in the conscious patients in the groupof surgical treatment and 5.6%in the group of con-servative treatment;it was 32%in the patients withsomenolence or in mild Corna in the group of surgical treatment and 62,5%in the group of conservativetreatment;it was 62%and 100%respectively in thepatients in moderate coma in the two groups;it was85%and100%respectively in patients in deep comain the two groups.Mortality rate was 52.3%and72.7%respectively in the patients with pulmonary infections in the two groups, while it was 43.2%and66.6% respectively in the patients withgastrointestinal bleeding in the two groups。Cerebralhernia had a mortality rate of54.4%and 75%respectively in the two groups.Mortality was40%inDatients who had undergone a second surgery and100%in the patients with repeated bleeding in thegroup of conservative treatment.It was shown that,except for conscious patients,surgical interventioncould lower the mortality,the therapeuticeffectiveness of surgery was good for hemorrhage inthe cerebellum,subcortical area, basal nuclei,andcerebral ventricles,and the mortality rate was lowerin the group of surgical treatment than thegroup ofconservative treatment when tbe amount of bleehgin the basal nuclei was less less than 30 ml.