高血压脑出血不同治疗方法比较分析

Comparison of Different Methods for the Treatment of Hypertension

【目的】比较高血压脑出血内科保守治疗、微创颅内血肿清除术、小骨窗开颅手术的三种治疗方法的疗效。【方法】将60例血肿量为30-40mL的壳核高血压脑出血患者分为A、B、C三组，其中A组20例行内科保守治疗；B组19例行微创颅内血肿清除术治疗；C组21例行小骨窗开颅手术治疗。比较三组治疗后6个月日常生活能力（ADL）评分。【结果】A组Ⅰ级6例，Ⅱ级8例，Ⅲ级5例，死亡Ⅰ例；B组Ⅰ级10例，Ⅱ级5例，Ⅲ级2例，死亡2例；C组Ⅰ级16例，Ⅱ级3例，Ⅲ级2例。C组分别与A组及B组相比差异有显著性（P〈0．05）。【结论】小骨窗开颅手术治疗高血压脑出血较其他两种方法的优势在于能在直视下彻底清除血肿，止血确切，能较迅速降低颅内压，防治脑水肿，提高疗效。

[Objective]To compare the effects of conservative treatment, minimally invasive evacuation of intracranial hematoma and small bone window craniotomy for the treatment of hypertensive cerebral hemorrhage. [Methods]Sixty patients with hypertensive cerebral hemorrhage of the putamen with 30-40 mL hema toma volume were divided into group A, B and C. Group A（ n =20） received conservative treatment. Group B （n =19） underwent minimally invasive evacuation of intracranial hematoma. Group C（ n = 21） underwent small bone window craniotomy. The activities of daily living（ADL） scores among three groups at 6 months after treatment were compared. [Results]In group A, 6 cases were grade Ⅰ , 8 cases were grade Ⅱ , 5 cases were grade Ⅲ and 1 case died. In group 13, 10 cases were grade Ⅰ, 5 were grade Ⅱ , 2 were grade Ⅲ and 2 died. In group C, 16 cases were grade Ⅰ , 3 were grade Ⅱ and 2 were grade Ⅲ. There was significant difference between group C and group A or B （ P 〈0.05）. [Conclusion] Small bohe window craniotomy for treating hypertensive cerebral hemorrhage is better than the other two methods because it has the advantages of corn pletely removing the hematoma under direct vision, accurately stopping bleeding, rapidly reducing intracranial pressure, preventing brain edema and improving the effect.