老年重症高血压脑出血患者的微创治疗

Minimally invasive surgery for massive intracerebral hemorrhage in elderly patients

目的探讨颅内血肿微创清除术(微创术)治疗老年重症高血压脑出血患者的疗效。方法对30例60岁以上、基底节区高血压脑出血、血肿量大于60ml的患者,采用脑CT片进行穿刺点定位,YL1型颅内血肿粉碎穿刺针对血肿进行穿刺、液化、引流,评估其病死率、好转率及治疗3周时神经功能评分,并与单纯药物治疗组(30例)进行比较。结果微创术治疗组死亡8例,病死率26.7%,好转22例,好转率73.3%;保守组死亡15例,病死率50.0%,好转15例,好转率50.0%。治疗组病死率显著低于单纯药物治疗组(P<0.01),好转率则显著高于单纯药物治疗组(P<0.01);治疗3周时微创术组神经功能评分(16.52±4.76)分,单纯药物治疗组(22.47±5.83)分,2组差异有非常显著意义(P<0.01),提示微创术治疗组患者神经功能恢复程度好于单纯药物治疗组。结论微创术治疗老年重症高血压脑出血患者效果较好,值得临床应用。

Objective To investigate the therapeutic effect of ,finimally invasive surgery On massive intracerebral hemorrhage in elderly patients.Methods 30 elderly patients（age 〉 60 yr） with massive intracerebral hemorrhage（hemorrhage volume 〉 60 ml） were treated with YL-1 type drill apparatus under CT graph control, and the outcome such as moaality, survival rate and nervous function scale 3 weeks after treatment were compared with those of control group. Results In minimally invasive surgery group, the mortality was 26.7% （8 cases）, survival rate was 73.3 % （22 cases）, the nervous function scale 3 weeks after treatment was （ 16.52 ± 4.76）, while the mortality was 50.0% （15 cases） in control group, survival rate was 50.0% （15 cases） and nervous function scale was （22.47 ± 5.83）. There were significant differences between two groups （ P 〈 0.01 ）. The results showed that minimally invasive surgery group had a better outcome in nervous function recovery than thet of control group. Conclusion Minimally invasive surgery is an effective therapy for elderly patients with massive intracerebral hemorrhage.