34例高血压脑出血开颅与微创清除血肿分析

Analysis of the evacuation of intracerebral hemorrhage in 34 patients with hypertensive intracerebral hemorrhage by craniotomies and minimally invasive surgeries

目的:探讨微创与开颅血肿清除术对高血压脑出血治疗的可行性和有效性,为临床提供适宜的治疗措施。方法:应用开颅血肿清除治疗高血压脑出血18例,应用微创血肿清除治疗高血压脑出血16例。结果:开颅血肿清除抢救成功12例,抢救成功率66.6%。微创血肿清除抢救成功8例,抢救成功率50%;其中出血8h内手术12例,抢救成功4例;4例在出血后3～5d手术均抢救成功。结论:高血压脑出血早期,血肿量大,中线移位明显,特别是伴有脑疝时,应开颅血肿清除。出血早期因微创术有引起再出血的危险,要慎用。出血3d后的患者,出血已停止,血肿已液化,适宜微创血肿清除。

Objective： To discuss the feasibility and effectiveness of the evacuation of intracranial hematoma by craniotomies and minimally invasive surgeries in treating patients with high blood pressure and intracerebral hemorrhage in order to provide proper clinical treatment measures to patients.Methods： The removal of cerebral hematoma by craniotomies were used to treat 18 patients with high blood pressure and cerebral hemorrhage,while the clearing of cerebral hematoma by minimally invasive surgeries were applied to 16 patients.Results： 12 cases were successfully rescued by craniotomies,with a successful rescue rate of 66.6%;while 8 cases were successfully rescued by minimally invasive surgeries,with a success rate of 50%.Of the patients,12 cases were performed surgeries after cerebral hemorrhage within 8 hours,and 4 were successfully rescued;4 cases were successfully rescued after 3 to 5 days＇ cerebral hemorrhage.Conclusion： In the early phase of cerebral hemorrhage,the intracranial hematoma（ICH） volume is large,patients are with obvious displacement in the brain midline structures and especially accompanied by brain hernia,who should be performed craniotomies.Minimally invasive surgeries which may result in patients＇ rebleeding in the early hemorrhage,should be cautious in using.Patients,after 3-day hemorrhage,the bleeding has stopped and the hematoma has already been liquified,are suitable for minimally invasive surgeries to clear the hematoma.