小脑出血74例临床诊断治疗体会

Clinical experience in the diagnosis and treatment of 74 cases of erebellar hemorrhage

目的:讨论小脑出血的临床特点、治疗策略选择和疗效分析。方法:总结2009年1月至2014年1月期间,包医一附院收治的小脑出血患者74例,小脑半球出血<10 m L的选择内科保守治疗;有脑干受压表现,血肿破入第四脑室,导致脑室系统梗阻者行侧脑室穿刺引流。小脑半球出血量≥10 m L患者,经家人同意后先行侧脑室穿刺引流术,再行小脑血肿微创穿刺清除术。对患者的临床特点,治疗经过和疗效进行回顾性分析。结果:74例患者中,小脑血肿量<10 m L者38例,其中有5例出现脑干受压和梗阻性脑积水,给予侧脑室穿刺清除术,其余均给予内科保守治疗;小脑出血量≥10 m L者36例,其中有4例因患者家人拒绝手术而只行内科保守治疗,均死亡外,有13例行单纯侧脑室穿刺引流术,19例行侧脑室穿刺引流联合小脑血肿穿刺清除术。保守治疗组有效率81.0%,死亡率18.9%。手术治疗组有效率86.4%,死亡率16.2%。主要死亡原因是脑疝。结论:在临床中一定要根据患者临床特点、血肿量和对脑干及脑室引流的影响,综合考虑,选择合理的治疗方案,是提高小脑出血预后和生存率的关键。

Objective：To discuss the clinical characteristics, selection and efficacy of treatment strategies of cerebellar hemorrhage. Methods：74 cases of cerebellar hemorrhage in the First Affiliated Hospital of Baotou Medical College from January 2009 to January 2014 were retrospectively analyzed. The patients whose volumes of hematoma are less than 10 ml adopted conservative medical treatment, and the patients, with mass effect on the brainstem and fourth ventricle hematoma, adopted lateral ventriculopuncture drainage when ventricular sys-tem obstruction occurred. The patients whose volumes of hematoma are equal or more than 10 ml, with the permission of their family, were treated with lateral ventriculopuncture drainage and then microinvasive craniopuncture therapy. The cases were retrospectively analyzed based on the clinical characteristics, treatment process and its efficacy. Result：In the 74 cases, there were 38 cases whose volumes of hematoma are less than 10 mL, in which 5 cases with brain stem compression injury and obstructive hydrocephalus were treated with lateral ventricu-lopuncture drainage. The other 33 cases were given conservative medical treatment. The volumes of hematoma in 36 cases are equal or more than 10 mL, in which 4 patients died of conservative medical treatment because of their family＇s rejection of operation. 13 cases received lat-eral ventriculopuncture drainage and 19 cases received lateral ventriculopuncture drainage combined with microinvasive craniopuncture thera-py. The conservative medical treatment is 81. 0% effective in the treatment of cerebellar hemorrhage, with the death rate 18. 9%. The ef-fective rate of surgical treatment is 86. 4% and the death rate 16. 2%. The main cause of death was cerebral hernia. Conclusion：A reason-able choice of treatment is made on the basis of characteristics of patients, hematoma volume and the impact of drainage on the brain stem and ventricle, which is the key to improve cerebellar hemorrhage prognosis and enhance survival rate.