急诊科开展神经内镜治疗自发性脑出血的可行性探讨

Value of neuroendoscope in the treatment of spontaneous cerebral hemorrhage in the emergency department

目的探讨急诊科开展神经内镜手术治疗自发性脑出血的可行性.方法1999-07～2003-12我院急诊科开展神经内镜手术治疗自发性脑出血101例,对其时效性、疗效、并发症等方面进行分析.结果从入院到手术间隔时间为68.6±38.3 min.出血部位在基底节51例,脑叶27例,丘脑9例,血肿破入脑室11例,单纯脑室出血3例.出血量20～130mL,平均53.3±36.8 mL,手术时机为发病7 h以内36例,7-72 h43例,超过72 h 22例.手术时机越早,其疗效越好,并发症发生越少.同时,血肿量越大,疗效也越差(P＜0.001).结论急诊科应用神经内镜治疗自发性脑出血具有时效性、整体性和微创性的统一,扩大了手术指征,值得进一步研究和推广应用.

Objective To evaluate the application of neuroendoscope to the treatment of spontaneous cerebral hemorrhage in emergency department.Methods From July 1999 to December 2003, 101 patients with spontaneous cerebral hemorrhage were operated by using neuroendoscope in our department. We retrospectively analyzed the therapeutic efficacy, time - effect and complications among the three groups according to different onset - operation intervals. Results Intervals between admission and operation were 68.6±38.3 minutes. The positions of hematoma were in basal ganglion（51 cases）, brain globe（27 cases）, thalamns（9 cases）, and hematoma ruptured into the ventricle （ 14 cases） .The volume of hematoma was from 20 mL to 130 mL, the average volumes were 53.3±36.8 mL.36 patients were operated within 7 hours from onset,43 cases in 7 - 72 hours and 22 cases over 72 hours.The earlier the operation time was,the better functional recovery was and the fewer complication was. In addition, the progress was negatively related to the volume of hematoma. Conclusion The application ot neuroendoscope to the treatment of spontaneous cerebral hemorrhage in emergency department has time - effect, integration and minimal invasion, and was worth advanced study.