立体定向治疗高血压轻中型脑出血的临床探讨

Stereotaxis method in treatment of light and medium type hypertensive intracerebral hemorrhage

目的探讨立体定向治疗高血压脑出血的适应证及手术时机。方法对63例出血量在20-60ml之间,GCS评分≥6分的高血压脑出血病人施行了CT定位立体定向手术治疗及术中、术后尿激酶溶解方法。结果63例无1例死亡,术后第3天和第7天分别复查头颅CT,术后第3天血肿消除量达到80%的54例,术后1周时有60例血肿清除量达到了90%以上。住院期间(平均住院12d)症状均有不同程度改善。3个月后随访,按日常生活能力(ADL)分级,ADL119例,ADL226例,ADL312例,ADL46例,ADL50例。结论轻中型高血压脑出血病人用立体定向手术方法治疗近期内可取得良好效果,缩短了病人的住院时间,降低了致残率,提高了患者生存质量。

Objective To explore the opportunity and indication of stereotaxis method in treatment of light and medium type hypertensive intracerebral hemorrhage for standardizing the surgical therapy. Methods Sixty-three cases of hypertensive cerebral hemorrhage with blood volume 20 - 60 ml and Glassgow coma scale ≥6 were studied. The patients were operated by stereotaxis method using CT scan. The remain hematoma were dissolved using urokinase after operation. Results No patient died in 63 cases. The clearance rate of hematoma was 80 % in 54 cases at day 3 after operation, and exceeded 90 % in 60 cases in a week after operation. The average hospitalization time was 12 days. All patients were improved during hospitalization. Based on the ADL scale after 3- month follow-up, ADL1 was 19 cases, ADL2 26 cases, ADL3 12 cases, ADL4 6 cases, ADL5 0 case. Conclusion The stereotaxis method has a good effect on light and medium type hypertensive intracerebral hemorrhage, shorten the hospitalization time, lower the mutilation rate, and improve the survival quality.