高血压脑出血的手术治疗(附80例报道)

Surgical Treatment of Hypertensive Intracerebral Hemorrhage

目的探讨高血压脑出血不同手术方法的适应症、提高疗效的注意事项。方法选择我科80例高血压脑出血患者,全部病例均经头颅CT扫描证实诊断、判断出血量。采用大骨瓣开颅血肿清除去骨瓣减压术、小骨窗开颅(直径<3cm)血肿清除术、锥颅血肿碎吸引流术和脑室穿刺引流术等手术方法进行治疗。结果各种手术方式有不同的手术疗效。手术时机与死亡率有直接关系,发病后6小时内手术者死亡率14.8%,6～24小时内手术者死亡率25%,24小时后手术者死亡率30.7%。结论对诊断明确、血肿量较大、不宜保守治疗者,尽早争取早期或超早期手术治疗。只有灵活掌握手术指征,掌握脑卒中个体化治疗的原则,才能有效地降低病死率及致残率。

Objective To investigate the indications of different technique in patients with hypertensive intracerebral hemorrhage and it's attention to improving curative effect. Method 80 patients with hyper- tensive intracerebral hemorrhage were selected and whose diagnosis and hemorrhage volume were approved by CT scans. All cases were treated by clearance of hematoma by craniotomy with bigger bone flap, clearance of hematoma by craniotomy with smaller born window, fragmentation, aspiration and drainage of hematoma by awl or ventriculopuncture.Results Various operations had different curative effects. There was a direct relationship between operative time and death rate, the death rate was respectively 14.8%, 25%, 30.7% within 6 hours, 6~24 hours and after 24 hours. Conclusion Early or super-early operations should be underwent to the patients who have clear diagnosis, biggish hematomas or unfavorable conservative treatment. Only grasping indications and therapeutic principle is the good way to decrease mortality and morbidity.