微创颅内血肿清除术治疗中、重度高血压脑出血的围手术期对策

Perioperative strategy for treatment of ultra-early minimally invasive surgery for severe hypertensive intracerebral hemorrhage

目的探讨微创颅内血肿清除术治疗中、重度高血压脑出血的围手术期措施。方法在ICU,对38例采用YL-1型颅内血肿穿刺针在简易立体定向仪定位下对颅内血肿行抽吸、粉碎冲洗,术后残血行尿激酶液化引流。对于血肿破入脑室者同时行脑脊液净化治疗。围手术期所有病例以危重病医学理论脏器功能监测与支持,早期发现并积极防治各种并发症。结果存活31例(81.6%),死亡7例(18.4%)。存活者中日常生活能力(ADL)评定:ADL 1 3例,ADL 2 12例,ADL 3 10例,ADL 4 5例,ADL 5 1例。结论加强围手术期的监测和综合治疗,可明显增进中、重度高血压脑出血微创血肿清除术效果,降低患者的死亡率、致残率。

Objective To investigats the perioperative strategy for treatment of severe hypertensive intracranial hemorrhage（HCH） by ultra-early minimally invasive surgery. Methods 38 patients with intracranial hematoma punccure（YL-1）underwent operation. The puncture point was located according to the stereotactic data of CT. All patients were treated by a single or more targets approaches and the tube was left as drainage in place for further administration of urokinase and aspiration of the residual dissolved hematoma. Purification of cerebrospinal fluid was also done with intraventricular hematomas. All the cases were administrated through the perioperative strategy with the critical care medicine theory. The function of the organs was positively monitored and supported so as to prevent the various complications early. Results 31 of the 38 cases survived（survival rate 81.6%）,and 11 cases died because of various causes （mortality rate 18.4 % ）. The score of ADL in the survivances ： ADL1 3 cases, ADL2 12 cases,ADL3 10 cases, ADL4 5 cases,and ADL5 1 case. Conclusion The enhanced treatment during the perioperative strategy can significantly improve the clinical effect of minimally invasive surgery for severe hypertensive intracerebral hemorrhage,and decrease the mortality and the rate of deformity.