高血压脑出血外科治疗策略

Surgical treatment strategy of 151 cases of hypertensive intracerebral hemorrhage

目的:探讨高血压脑出血外科治疗策略。方法:回顾性分析68例钻孔引流、54例小骨窗开颅、29例行骨瓣开颅血肿清除治疗高血压脑出血患者的临床资料,对比三组患者的术前病情及治疗效果。结果:三组比较,钻孔引流组平均年龄最大,术前GCS评分最高,平均血肿量最少,术后死亡率最低,与小骨窗开颅组疗效比较,差异无统计学意义(P>0.05),好于骨瓣开颅组。骨瓣开颅组平均年龄最小,术前GCS评分最低,血肿量最大,术后死亡率最高,疗效较差。结论:对于高血压脑出血患者,应根据血肿量、意识状态演变,有无脑疝、脑室内积血、脑积水、患者全身情况综合评定,并根据家属意愿,选择合适的手术方式。

Objective： To explore the surgical treatment strategy of hypertensive intracerebral hemorrhage.Methods： The clinical date of 151 cases of hypertensive intracerebral hemorrhage were retrospectively analyzed.Among of them,there are 68 cases of trepanation and drainage,small bone window of 54 cases,and 29 cases treated by bone lobe.The preoperative condition and therapeutic efficacy of the three groups were compared.Results： There were significant differences on results.In the trepanation and drainage group,the mean age was the biggest,preoperative GCS score was the highest,average hematoma was the least and the postoperative death rate was the lowest.In the bone lobe group,the mean age was smallest,preoperative GCS score was the lowest,average hematoma was the largest and the postoperative death rate was the highest.The curative effect on trepanation and drainage group and small bone window group had no difference,but was significantly better than the bone lobe group.Conclusion：Hypertensive intracerebral hemorrhage is a disease that has a high incidence rate and high morbidity rate.The volume of hematoma,variation of conscious state,cerebral hernia,hematocele in ventricle,hydrencephaly and status of the patients should be considered when choosing the operation method.The wish of family member is also very importment to the choice.