不同术式治疗高血压脑出血的临床研究

Clinical therapeutic effect of different surgical approaches on the hypertensive intracerebral

[目的]探讨治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)适宜的手术方法,为临床治疗提供依据。[方法]212例高血压脑出血分为开颅组与钻孔引流组,根据术前出血部位、血肿量、意识状况分别采取骨瓣开颅血肿清除术和钻孔穿刺抽吸引流术,观察术后24 h GCS评分、FAM、ADL,了解其预后。[结果]微创钻孔引流平均手术时间(1.0±0.5)h较骨瓣开颅平均手术时间(4.5±1.6)h明显缩短(P<0.05);术后3 d内再出血率微创钻孔引流组6/102(5.88%),开颅组5/110(4.55%)(P>0.05);微创钻孔引流组术后24 h平均GCS评分(12.47±5.16)、FAM(15.34±2.57)、ADL比例(优良76.47%)高于延迟开颅组GCS评分(10.23±4.83)、FAM(12.67±2.18)、ADL(优良55.77%)(P<0.05);微创钻孔引流组死亡22/102(21.57%),开颅组早期术后死亡12/58(20.69%),延迟术后死亡16/52(30.77%),死亡率延迟组高于微创钻孔引流组和早期组(P<0.05)。[结论]严格掌握手术适应证,早期进行微创手术治疗可获得满意效果。

[Objective]To evaluate and explore the appropriate operation method for hypertensive intracerebral hemorrhage（HICH）.[Methods]The operations of learning hematoma by craniotomy with bone flap were performed in 110 cases and the other 102 cases of HICH had minimally invasive puncture suction drainage according to the situation and volume of hemorrhage and consciousness status.The 24 h GCS score,FAM and ADL were assessed for the prognosis of the two operations.[Results]The average operation time of the minimally invasive puncture suction drainage was（1.0±0.5）h,shorter than that of craniotomy with bone flap,（4.5±1.6）h（P0.05）.In addition,re-bleeding rate had no difference in minimally invasive puncture suction drainage and craniotomy with bone flap after three days of the operation,5.88%（6/102） vs 4.55%（5/110） respectively（P0.05）.Furthermore,the GCS score（12.47±5.16）,FAM（15.34±2.57） and ADL rate（76.47%） in minimally invasive puncture aspiration drainage were higher than those in craniotomy with bone flap,GCS score（10.23±4.83）,FAM（12.67±2.18）,high ADL rate（55.77%） respectively（P0.05）.Finally,the postoperative mortality,30.77%（16/52） was higher in delayed craniotomy group than that in minimally invasive puncture aspiration drainage,21.57%（22/102） and early craniotomy group 20.69%（12/58,P0.05）.[Conclusion]To grasp surgical indications strictly are needed and early minimally invasive surgery can obtain satisfactory results at hypertensive intracerebral hemorrhage（HICH） patients.