早期小骨窗开颅手术治疗181例高血压大量脑出血

Small hole craniotomy in super-early stage for treating large amount intracerebral hemorrhage of hypertensive

目的探讨早期小骨窗开颅治疗出血量较大的高血压脑出血的效果。方法对181例出血量较大的幕上高血压脑出血病人分为3组,分别采用早期小骨窗开颅、大骨窗开颅并减压和穿刺抽吸引流等不同手术方式治疗,并对效果进行分析。结果早期小骨窗开颅组死亡19例(30.6%),恢复良好7例,中度病残26例,重残9例,植物生存1例;大骨窗开颅并减压组病人死亡30例(50.0%)恢复良好2例,中度病残15例,重残13例。穿刺引流组病人死亡30例(50.8%)恢复良好2例,中度病残14例,重残13例。三组差别有统计学意义(χ2=6.489,P=0.039)。结论早期小骨窗开颅手术在治疗出血量较大的高血压脑出血中效果更好,能有效降低死亡率。

Objective To explore the effects of small hole craniotomy in super early stage on large-amount of hypertensive intracerebral hemorrhage. Methods 181 cases of large-amount of hypertensive intracerebral hemorrhage were divided into 3 groups. Different surgical operative treatment, such as small hole craniotomy in super early stage, trauma maximus bone flap craniotectomy decompression and aspiration by drilling cranium were used in different group. The clinical data were retrospectively analyzed. Results In the group of small hole craniotomy,there were 7 cases recovered weII, 26 cases moderately disabled, 9 cases severely disabled, 1 case was under vegetative state and 19 cases（30. 6% ） died. In the group of trauma maximus bone flap cranioteetomy decompression, there were 2 cases recovered well, 15 cases moderately disabled, 13 cases severely disabled and 30 eases（50%）died. In the group of aspiration by drilling cranium, there were 2 cases recovered well, 14 cases moderately disabled, 13 cases severely disabled and 30 cases（50.8%）died. There were significantly differences between the three groups （Х^2 =6. 489, P=0. 039）. Conclusion Small hole craniotomy in super early stage is a preferable method of treating large-amount of hypertensive intracerebral hemorrhage.