手术方法对高血压脑出血脑室血肿近期临床疗效影响

The influence of surgical methods on recent clincal effect of hypertensive intracerebral hemorrhage and hypertensive intracerebral hemorrhage

目的探讨不同手术方法对高血压脑出血脑室血肿术后30 d临床疗效影响。方法对笔者所在医院收治的78例高血压脑出血破入脑室形成血肿且血肿量大于30 ml的患者术后30 d临床资料按照手术方法不同分为两组:微创钻孔血肿抽吸及侧脑室前角穿刺外引流组和开颅血肿清除及侧脑室前角穿刺外引流组。对术后30 d内生存状况、血肿消失时间、脑室扩大进行对照研究。结果微创组42例术后30 d存活34例(81%),GCS评分平均10.1分,血肿平均消失时间为3.6 d,脑室扩大6例;开颅组36例术后30 d存活22例(61.1%),GCS评分7.2分,血肿平均消失时间为6.5 d,脑室扩大16例。对两组存活率比较无明显差异(P>0.05);对两组术后GCS评分、血肿平均消失时间、脑室扩大率比较:微创组疗效均优于开颅组,差异有显著性(P<0.05)。结论微创钻孔血肿抽吸及侧脑室前角穿刺外引流治疗高血压脑出血脑室血肿手术简单,创伤小,术后血肿消失早,脑室扩大率低,预后较好。

Objective To exporc the influence of different surgical methods on clincal effect within the postoperative 30 days of cerebroventricular hematoma （CVH） and hypertensive intracerebral hemorrhage （HICH）. Methods 78 cases of HICH and CVH with more than 30 nfl hematoml were divided into 2 groups according to operation method ： sphenotresia group with punction and aspiration of hematoma ＋ antecornu ＋ postcomu and craniotomy group with external drainage of lateral cerebral ventricl and contrasted study of GCS scores within the postoperative 30 days and extinction time of intracerebral hematoma and ventriculomegaly. Results 34 cases （ 81% ） of 42 ones in stereotaxis group survive and postoperative GCS scores means 10. 1 score, extinction time of intracerebral hematoma means 3.6 d and 4cases with ventriculomegaly within the postoperative 30 days;22 cases（61.1% ） of 36ones in craniotomy group survive and postoperative GCS scores means 7.2 score,extinction time of intraeerebral hematoma means 6.5d and 16 cases with ventriculomegaly within the postoperative 30 d. To analyse survival rate between two groups show no significance （ P 〉 0. 05 ） ; To analyse postoperative GCS scores and extinction time of intracerebral hematoma and incidence rate of ventriculomegaly between groups ： stereotaxis group show significant difference （P 〈 0. 05 ） in contrast to craniotomy one. Conclusion sphenotresia punction and aspiration of hematoma ＋ anteeomu ＋ postcornu treating HICH and CVH manifests operation trauma tinyer and simpler, extinction time of eerebroventrieular hematoma earlier ,ineidenee rate of ventriculomegaly lower , survival quality better.