高血压脑出血早期微创手术方法的选择及疗效分析

Selection and effect analysis on early minimally invasive operation for the treatment of hypertensive intracerebral hemorrhage

目的探讨高血压脑出血早期微创手术方法的选择原则及疗效。方法分析三年中收治的160例患者,其中男94例,女66例,年龄28～84岁,所有患者入院前均有高血压病史,手术均在发病后6～12小时内进行。根据患者的CT结果,并结合患者意识状况,采取不同的微创手术方法。结果160例患者中95例行血肿钻孔引流术,49例行双侧脑室外引流术,10例患者行小骨窗开颅血肿清除术,6例行一侧脑室外引流术。术后生存126例,死亡34例。生存患者随访3个月～3年,ADLⅠ级33例,Ⅱ级31例,Ⅲ级45例,Ⅳ级34例,Ⅴ级18例。手术优良率为68.13%(109/160),死亡率为21.25%(34/160)。结论高血压脑出血微创手术方法的选择主要取决于出血部位和出血量,同时患者术前的意识和瞳孔演变也是重要的参考因素。微创手术能够降低患者的死亡率,提高患者的生活质量。

Objective To explore the principle of selection and effect on early minimally invasive operation for the treatment of hypertensive intracerebral hemorrhage. Methods 160 cases were analysized in 3 years , with 94 males and 66 females. Their age ranged from 28 to 84 years old. All the patients had the history of hypertension before the admission. The operations were performed 6-12 hours after the onset. Different minimally invasive operations were performed according to the patients＂ CT result and conscious status. Results Hematoma trepanation and drainage were performed in 95 cases, bilateral ventricles outer drainage in 49 cases, hematoma evacuation of key--hole approach in 10 cases, and one side of lateral ventricle outer drainage in 6 cases. After the operation 126 cases were alive, and the other 34 cases dead. The 3 months to 3 years follow--up of the alive showed level I of ADI. （Activity of daily living） in 33 cases, level ]1 in 31 cases, level III in 45 cases, level iV in 34 cases and level V in 18 cases. Satisfactory rate was achieved in 68. 13%（109/160）,and mortality rate in 21.25%（34/160）. Conclusion The selections on early minimally invasive operation for the treatment of hypertensive intracerebral hemorrhage mainly rely on the location and quantity of intracerebral hemorrhage. Meanwhile the patients＇ consciousness and pupil changes are also important reference factors. At the same time, the operation can lower the mortality rate and increase the life quality.