高血压脑出血(血肿量40～60ml)手术方式探讨

THE EXPLORATION OF SURGICAL METHODS ON HYPERTENSIVE CEREBRAL HEMORRHAGE WHEN HEMATOMA VOLUME IS BETWEEN 40 AND 60 ML

目的探讨血肿量40～60 ml的高血压脑出血的手术方式。方法对54例高血压脑出血(血肿量40～60 ml)患者分别行开颅血肿清除术和血肿穿刺引流术,术后采用经颅多普勒超声(TCD)监测每例患者术后的双侧大脑中动脉平均血流速度(VmMCA)、搏动指数值(PI),并抽血监测颈内静脉血与动脉血乳酸差值(VALa),将两组数据作比较。结果开颅血肿清除组的双侧VmMCA普遍高于血肿穿刺引流组,PI值均低于血肿穿刺引流组(p<0.05);开颅血肿清除组VALa均值小于血肿穿刺引流组(p<0.05)。结论对于血肿量40～60 ml的患者应选择开颅手术。

Objective To explore the surgical methods on hypertensive cerebral hemorrhage when hematoma volume is between 40 and 60 ml. Methods Fifty - four cases of hypertension cerebral hemorrhage patients were randomized to eraniotomy and hematoma cavity drainage ,after surgery their Vm and PI of the bilateral MCA（VmMCA） as well as arteriovenous difference of lactic acid （VALa） were monitored and compared. Results The VmMCA of patients with eraniotomy were significandy faster than drilling drainage group, the PI and VALa of patients with craniotomy were significantly lower than drilling drainage group（p 〈 0. 05 ）. Conclusion Patients whose hematoma volume is between 40 and 60 ml should choose cranioto- my.