微创清除术治疗高血压脑出血临床观察

CLINICAL OBSERVATION ON MINIMAL INVASIVE EVACUATION IN HYPERTENSIVE CEREBRAL HEMORRHAGE

目的观察微创穿刺血肿抽吸引流治疗与内科保守治疗高血压性脑出血的临床效果,同时观察微创组引起再出血的相关因素。方法对照组主要以甘露醇脱水,补液等综合治疗为主;微创组除与对照组采用相同内科治疗外,同时于发病1～72h内根据头颅CT显示的出血情况,选择穿刺方式、部位、穿刺针的长度,予血肿穿刺抽吸及冲洗。观察二组治疗后的总显效率、病死率以及微创组中可引起再出血的相关因素。结果微创穿刺血肿抽吸引流治疗高血压脑出血的总显效率为80.3%,病死率为16.2%,对照组总显效率为50.0%,病死率为36.6%,二组比较差异有统计学意义(P<0.01)。同时亦了解到再出血与血压调控,手术时机操作,穿刺定位,操作流程规范性,脑出血早期(<6h)使用甘露醇脱水等相关因素有关。结论微创穿刺血肿引流治疗高血压脑出血适用于各级医院,再出血相关因素是可预防的。

Objective To observe the clinical efficacy of minimal invasive puncture hematoma aspiration and drainage and medical conservative therapy in hypertensive cerebral hemorrhage, and to explore the corresponding factors that induce the recurrent hemorrhage in surgery group. Methods The control group underwent dehydration by mannitol, fluid infusion and other combined treatments. Besides the same combined treatments as the control＇s, the treatment group underwent hematoma aspiration and washed at 1-72 hours after the onset of disease. The mode and site of aspiration and the length of needle were determined by the hemorrhage conditions displaying by cranial CT scanning. Observation on the total effective rate, mortality of the two groups and the corresponding factors which may induce the recurrent hemorrhage in the surgery group were investigated. Results The total effective rate of minimal invasive puncture hematoma aspiration and drainage to treat hypertensive cerebral hemorrhage was 80.3% and mortality was 16.2%, while the total effective rate of control group was 50. 5% and mortality was 36.6%, which had a statistical significance between the two groups （P〈0.01）. Meanwhile, the corresponding factors such as blood pressure modulation, operation opportuni- ty selection, aspiration positioning, the standard operation procedure, the early stage of cerebral hemorrhage （〈6 hours） and the use of mannitol were observed to be related to the occurrence of recurrent hemorrhage. Conclusion The minimal invasive puncture hematoma aspiration and drainage is applicable in hospitals at all levels in treating hypertensive cerebral hemorrhage; the corresponding factors of recurrent hemorrhage are preventable.