小骨窗开颅与立体定向穿刺手术治疗高血压脑出血的对比分析

Comparative analysis of small bone window craniotomy and stereotactic operation in treatment for hypertensive cerebral hemorrhage patients

目的：对比采用不同外科术式的高血压脑出血患者，分析其术后并发症及远期生活能力的相关性。方法：回顾总结210例年龄〈85岁、GCS评分5～10分且出血量在40—80ml的患者，按小骨窗开颅和立体定向血肿穿刺两种手术方式分为2组，通过对高血压脑出血病人术前意识状态、出血部位和和出血量、手术方式等因素的回顾性研究，分析术后患者偏瘫开始恢复时间、再出血率、术后肺部感染发生率及远期生活能力等指标。结果：立体定向血肿穿刺与血肿开颅清除手术两者术后肺部感染发生率（x2=0．669，P=0．413）和术后迟发再出血率（x2=O．321，P=1．000）无差异，两种术式术后远期生活能力无差异（Z=0．469，P=0．639）。对于脑出血后意识障碍Ⅱ～Ⅲ级、深部小血肿和重要功能区血肿的患者，立体定向血肿穿刺术偏瘫开始恢复小于骨窗开颅（t=11．245，P=0．000）。结论：对于高血压脑出血患者，针对不同出血部位及出血量多少，早期采取个体化治疗，可以取得良好的治疗效果，能降低死亡率及病残率，提高生活质量。

Objective： To compare different surgical operation on hypertensive intracerebral hemorrhage patients,correlation analysis of complications and long-term life ability after operation. Methods： A retrospective review of 210 patients younger than 85 years, GCS score 5-10 and the amount of bleeding in 40~80ml patients, according to the two kind of operation mode of small bone window craniotomy and stereotactic hematoma puncture were divided into two groups in which the state of consciousness, hemorrhage retrospective study of factors, operation mode and the site of bleeding in patients with hypertensive intracerebral hemorrhage were retrospectively analysed. Postoperative patients with hemiplegic start recovery time, rebleeding rate, incidence rate and long life ability index of postoperative pulmonary infection were analysed. Results： ①The stereotactic hematoma and hematoma clearance rate of lung infection after operation were （X2=0.669,P=0.413）and late postoperative rebleeding rate（x2=0.321 ,P=I.000） in which there was no difference.No difference between the two kind of long-term viability after operation （Z=0.469,P=0.639）. ②For cerebral hemorrhage after the disturbance of consciousness, grade Ⅱ-Ⅲ deep small hematoma and hematoma were important functional area, stereotactic hematoma puncture hemiplegia recovery began less than bone window craniotomy （t=11.245, P=0.000）.Concluslon： For patients with hypertensive cerebral hemorrhage, in vie of the different bleeding position and volume how many, early taking individual treatment can obtain a good therapeutic effect, can reduce the mortality rate and disability rate, improve the quality of life.