微创穿刺粉碎清除术治疗高血压脑出血的临床研究

Clinical study on microtrauma puncture comminution clearing in the treatment of hypertensive intracerebral hemorrhage

目的 探讨使用微创穿刺粉碎清除术治疗高血压脑出血的临床疗效,及其与年龄、脑出血部位、血肿量、术前脑出血意识状况分级、手术时机选择之间的关系.方法 对43例高血压脑出血在CT定位下采用YL-Ⅰ型一次性使用颅内血肿粉碎穿刺针进行微创穿刺粉碎清除术治疗,疗效评价按ADL（日常生活能力）分级法.统计学处理采用H检验.结果 1例猝死,死于心脏病突发.3例再出血,因家属放弃手术而死亡.2例并发大面积脑梗死抢救无效死亡,3例死于肺部感染等并发症.34例恢复出院.随访3个月,按ADL分级,恢复良好（ADL1～3）23例,不良（ADL4～5）11例.结论 CT定位微创穿刺粉碎清除术治疗高血压脑出血的疗效较为满意.高血压脑出血的早期疗效与年龄的关系并不密切,而与脑出血的部位和血肿量的关系更大.出血为深部型、出血量大、出血速度快者疗效差.术前意识状况分级是决定脑出血患者预后的主要因素.高血压脑出血微创穿刺粉碎清除术的手术时机应尽可能采用超早期、早期.

Objective To explore the therapeutic effects of Hypertensive intracerebral hemorrhage treated by microtrauma puncture comminution clearing technique, and an analysis of the relationship between the therapeutic effects and the ages, sites of cerebral hemorrhage, hematoma volume, grading scale of impaired consciousness and time of operation were made. Methods 43patients with HICH were treated by YL - Ⅰ cype puncture needle in microtrauma puncture comminution clearing technique guided by CT localization, the therapeutic effects are made according to ADLgrade. The statistical treatment was made using H test. Results One patient fell a victim of sudden death because of abrupt attack of heart disease;3 had relapse of hemorrhage and passed away eventually because the operative treatment was given up by their family members ;2patients died from large area of infarction after salvage;3 died with pulmonary infecfion;34 were recovered and discharged from hospital. Follow - up for 3 months revealed- （ according to ADL grade） good recovery （ ADL 1 - 3） （ n = 23）, poor recovery （ ADL 4 - 5 ） （ n = 11 ）. Conclusion The therapeutic effects of HICH treated with microtrauma puncture comminution clearing technique guided by CT localization was satisfactory. The influence of patient＇ s age on the early therapeutic efficiency in HICH was not singificant , but the therapeutic efficiency was notably influenced by the hemorrhagic sites and hematoma volume; and poor results were noted in the deep type HICH and large volume hemorrhage and when the hemorrhage was rapid. The grade of preoperative consciousness in HICH patients plays a great role in the outcome of therapeutic efficiency. The time of operation in the treatment of HICH with microtrauma puncture clearing technique should be as early as possible,i, e. at the supra - early stage and early stage.