去骨瓣减压术在治疗高血压脑出血中的应用

The Application of Decompressive Craniectomy in the Treatment of Hypertensive Cerebral Hemorrhage

目的分析去骨瓣减压术在治疗高血压脑出血的应用价值。方法回顾性分析了25例行血肿清除加去骨瓣减压的高血压脑出血患者和同期23例行单纯血肿清除术患者的资料,比较死亡率及神经功能恢复情况,并分析其预后影响因素和高血压脑出血行去骨瓣减压的适应证。结果两组的性别分布、年龄、术前GCS评分、血肿量、瞳孔变化情况无显著性差异;平均随访时间为7个月,去骨瓣减压组25例患者中5例死亡,存活20例中,6例预后良好(mRS<4);单纯血肿清除组23例患者中12例死亡,存活11例中3人预后良好。组间死亡率有显著性差异(P<0.05),去骨瓣减压组(6/25)良好比例高于单纯血肿清除组(3/23)但两组间无显著性差异(P>0.05)。本组病例中,影响高血压脑出血行血肿清除加去骨瓣减压手术死亡率的重要因素包括:术前ICH评分、术前瞳孔对光反射。结论在高血压脑出血患者中选择性的开展血肿清除加去骨瓣减压手术有助于降低死亡率并改善功能预后。

Objective To evaluate the effect of decompressive eraniectomy （DC） on the treatment of hypertensive cerebral hemorrhage. Methods The data of 25 patients who underwent DC for hypertensive cerebral hemorhage （study group） and 23 patients who had similar conditions but underwent simple haematoma eetomy （control group） were analyzed. Results There were no statistical differences in data about patients＇ age, gender, GCS before operation, the volume of hematoma as well as the pupil reaction between two groups. The mean thne of follow-up was 7 months. In study group, 5 patients died and among the surviving 20 patients 6 had good results （mRS 〈 4）. In control group, 12 patients died and among the surviving 11 patients 3 had good outcome. There were statistical differences for death rate between the two groups （ P 〈 0.05）, but there were no statistical differences for the rate of patients having good outcome between the two groups （ P 〉 0.05）. Both ICH and pupil reaction before operation were important factors affecting the mortality in study group. Conclusions Decompressive eraniectomy may lead to lower death rate and better outcome on certain subtype of patients having hypertensive cerebral hermorrhage.