小骨窗开颅血肿清除术治疗高血压脑出血40例临床疗效分析

Treatment and curative effect of 40 cases with hypertensive intracerebral hemorrhage by hematoma clearance in craniotomy of small bone hole

目的评价小骨窗开颅血肿清除术在高血压脑出血中的治疗效果。方法高血压脑出血40例采用小骨窗开颅血肿清除术治疗,术后辅以血压控制、积极预防各种并发症、营养支持等治疗,必要时早期气管切开。结果术后24h内复查头颅CT,血肿清除>90%以上者11例,血肿清除50%～90%者21例,血肿清除30%～50%者8例,血肿清除总体效果满意。术后随访半年,死亡6例,余34例按照日常生活能力分级法:I级6例,II级14例,III级8例,IV级4例,V级2例。结论小骨窗开颅血肿清除术操作相对简单、进颅快、定位准确、脑损伤小,是高血压脑出血较为理想的手术方法。

Objective To investigate the clinical effect of hematoma clearance in hypertensive intracerebral hemorrhage （HICH） with craniotomy by small bone hole. Methods 40 cases of HICH were treated with craniotomy by small bone hole, then treating with controlling blood pressure, active prevention various complications, nutrition support and early tracheotomy after operation. Results With review of head CT after operations in 24 hours, the eleanance rate of hematoma of 11 cases exceeded 90%, 21 cases 50%-90%, 8 cases 30%-50%, the effect is satisfactory. According to activity of daily living scale after six months： 6 cases got Ⅰ-class, Ⅱ- class 14 cases, Ⅲ-class 8 cases, Ⅳ-class 4 cases, Ⅴ-class 2 cases. Conclusion Craniotomy by small bone hole is simple, quick, accurate and less injury, is a better surgical way for HICH.