微创治疗急性严重脑出血的临床研究

Treatment of severe intracerebral hemorrhage by microinvasive surgical therapy in emergency department

目的探索提高严重脑内血肿急诊救治成功率的新途径。方法以2006年1月—2007年12月间收治的189例GCS 3～8分的脑内血肿患者为研究对象,分为内科治疗组(即对照组,93例)和急诊微创穿刺组(微创组),对照组采用常规内科治疗,微创组患者则在CT引导下,用YL-1型颅内血肿粉碎穿刺针,在急诊抢救室内行微创血肿碎吸术,比较两组间的治疗效果。结果对照组96例,7、14 d和30 d分别死亡35、44例和57例,死亡率分别为25.0%、33.3%和46.7%;实验组93例,7、14 d和30 d分别死亡24、32例和45例,死亡率分别为37.6%、47.3%和61.3%。治疗后神经功能缺损评分比较,微创组7、14、30 d均明显优于对照组。结论早期微创脑内血肿清除显著提高脑内血肿的急诊救治成功率,是一项可在急诊抢救室内开展的脑内血肿救治的新方法。

Objective To study a new method to elevate the survival rate of patients with severe intracerebral hemorrhage. Methods From Jan. 2006 to Dec. 2007, 189 patients with intracerebral hemorrhage （ GCS score 3 - 8） were divided into two groups ： 93 cases accepted medical treatment as control group and 96 cases accepted microinvasive surgical therapy treated as microinvasive group in emergency department. Results On 7th, 14th and 30th day, there were 35, 44 and 57 cases died respectively, and the case-fatality rate was 37.6%, 47.3% and 61.7% in control group. But at the same time, 24, 32 and 45 cases died, and the case-fatality rate was 25.0%, 33.3% and 46.7% respectively in microinvasive surgical therapy group. The score of scandinavian stroke scale （ SSS ） in microinvasive surgical therapy was higher than the control group on 7th, 14th and 30th. Conclusion Microinvasive surgical therapy for severe intracerebral hemorrhage in emergency department significantly reduces the case-fatality rate and should be carried out in emergency department.