高血压基底节脑出血合并脑疝38例救治分析

STUDY ON TREATMENT OF 38 PATIENTS SUFFERING FROM HYPERTENSIVE HEMORRHAGE IN BASAL GANGLIA REGION COMBINED WITH CEREBRAL HERNIA

目的探讨高血压基底节脑出血脑疝患者的有效治疗方法及临床疗效。方法回顾分析2004年1月—2008年12月我科收治的高血压基底节区脑出血并脑疝患者38例,床旁采用YL-1型针穿刺抽吸部分血肿,缓解高颅压症状,后行标准大骨瓣开颅去骨瓣减压,经侧裂入路显微镜下清除残余血肿。术后早期采用亚低温、高压氧等综合治疗,定期随访,观察疗效。结果本组38例,无一例出现术后再出血,死亡5例,病死率13%。术后随访3～12个月,根据ADL分级法判定疗效,I级2例,Ⅱ级10例,Ⅲ级14例,Ⅳ级4例,Ⅴ级3例。结论 YL-1型针穿刺引流术联合标准大骨瓣开颅去骨瓣减压,经侧裂入路显微镜下清除血肿是高血压基底节区脑出血并脑疝行之有效的手术方法,术后期亚低温、高压氧等综合治疗可提高手术疗效,有效地降低病死率,提高患者的生存质量。

Objective To study the treatment and clinical effect of hypertensive hemorrhage in basal ganglia region combined with cerebral hernia.Methods Between Jan 2004 and Dec 2008,38 cases of hypertensive hemorrhage in basal ganglia region combined with cerebral hernia were admitted into our department,we retrospectively analyzed the surgical method,postoperative treatment and follow-up results of these patients.Results Postoperative bleeding were not occurred in any cases,5 patients died,fatality rate was 13%.Activities of daily living（ADL）evaluation in 3~12 months follow-up showed that 2 patients were ADL1（5%）,10 patients were ADL2（26%）,14 patients were ADL3（37%）,4 patients were ADL4（11%）,3 were ADL5（8%）.Conclusion Minimally invasive puncture drainage initially and then underwent standard large decompressive craniotomy,intracranial hemotoma removed microsurgically through lateral fissure approach is an effective surgical method for treatment of hypertensive hemorrhage in basal ganglia region combined with cerebral hernia,postoperative treatment such as hypothermia and hyperbaric oxygon therapy can enhance the improvement which could decrease the fatality rate and improve the quality of life.