立体定向血肿清除术治疗高血压脑出血的疗效与死亡相关因素分析

The clinical results and risk factor analysis of stereotactic evaluation for hypertensive intracerebral hematoma

目的 :评价立体定向血肿清除术治疗高血压脑出血的疗效并分析死亡相关因素。方法 :1986年 6月至1996年 10月 ,用CT引导立体定向血肿清除术治疗高血压脑出血 15 1例。男 10 5例 ,女 46例 ;年龄 37～ 90岁 ,70岁以上者 14例 ;意识 3～ 5分者 (Glasgow) 6 8例 ;血肿体积大于 10 0ml者 35例 ;血肿破入脑室者 33例。结果 :术后一月内良好率及轻残率分别为 2 5 2 %和 2 9 8% ,手术死亡率为 9 2 7% ,术后并发症发生率为 15 2 % ,其中术后再出血 4%。 12 2例随访 2个月至 10年 ,良好 39 3% ,轻残 2 7 9%。结论 :立体定向血肿排空术是治疗高血压脑出血的有效手术方法 ;高龄、血肿量大及术前血肿急性扩大仍是手术死亡的主要原因 ;虽然血肿破入脑室可明显加重病情 ,但适当处理可降低其死亡率 ;术后并发症的有效防治是降低手术死亡率的有效措施。

Objective:To analysis the clinical results and the death factor of stereotactic evacuation for hypertensive intracerebral hematoma.Methods:151 patients with a hypertensive intracerebral hematoma were treated by stereotactic evacuation between 1986 and 1996.There were 105 males and 46 females;their ages ranged from 37 to 90 years.Results:In one month after operation,the satisfactory rate,complications rate and mortality were 55%,15.2% and 9.27%,respectively.122 patients were followed up from 2 months and 10 years,the satisfactory rate was 67.2%.Conclusion:Stereotactic evacuation was an effective method for hypertensive intracerebral hematoma.The older,volume of hematoma more than 100ml,acute expansion of hematoma and the complications after surgery were the high risk factor of hypertensive intracerebral hematoma.\;