自发性脑内血肿急诊手术时机及方法选择的探讨

Selection of Therapeutic Opportunity and Operative Mode of Emergency Surgery for Spontaneous Intracerebral Haematoma

目的探讨自发性脑内血肿（spontaneous intracerebral haematoma SICH）的急诊手术时机和手术方法。方法采用回顾性研究方法，对我院神经外科2005年5月至2008年10月收治的SICH急诊手术患者86例进行分析。结果按国际Glasgow Outcome Scale（GOS）标准进行预后分类评分。高血压脑出血组60例，其中恢复良好12例（20．0％），中度残废17例（28．3％），重度残废13例（21．7％），植物生存7例（11．7％），死亡11例（18．3％）。非高血压脑出血组26例，其中恢复良好11例（42．3％），中度残废6例（23．O％），重度残废4例（15．4％），植物生存2例（7．7％），死亡3例（11．5％）。结论（1）自发性脑出血超早期、早期急诊手术较延期手术疗效好，是较好的手术时机。（2）急诊手术方式选择应根据病人的具体情况，影像学的特点，综合评价病人情况，采用个体化治疗方案。

Objective To study therapeutic opportunity and operative mode of emergency surgery in patients with spontaneous intracerebral haematoma （SICH） Methods Eightysix patients with SCIH in the neurosurgical department from May 2005 to October 2008 were analyzed by using retrospective study. Results According to the International Glasgow Outcome Scale （GOS） classification of prognosis score. In 60 cases of hypertensive intracerebral hemorrhage group, 12 cases （20.0%） were well recovered, 17 cases （28.3%） were mildly disabled, 13 cases （21.7% ） were severely disabled, 7cases （ 11.7% ） were survival as vegetative state, and 11 cases （ 18.3% ） were dead. In 26 cases of Nonhyper - tensive cerebral hemorrhage group, 11 cases （42.3 % ） were well recovered, 6 cases 123.0 % ） were mildly disabled, 4cases （15.4% ） were severely disabled, 2 cases 17.7%） were survival as vegetative state, and 3 cases （ 11.5 % ） were dead. Conclusion （ 1 / The effect of ultra - early or early surgical group is better than delayed surgical group. It is a good therapeutic opportunity. （2/ . The emergency surgical programs should follow the individual treatment according to the specific circumstances, imaging characteristics and a comprehensive assessment of patient.