微创血肿清除术治疗临界量高血压脑出血

Minimally Invasive Hematoma Evacuation tor Critical Hypertensive Cerebral Hemorrhage

目的：探讨微创血肿清除术治疗高血压脑出血患者中临界开颅手术出血量患者的疗效。方法回顾分析高血压脑出血患者55例，颅脑 CT 检查提示小脑幕上血肿，出血量介于20～30 mL，中线结构无明显偏移，其中29例采用微创手术治疗（微创组），26例采用内科保守治疗（对照组）。比较2组的住院时间，采用日常生活能力评分（ADL）评介治疗后4周神经功能情况并评价疗效。结果微创组住院时间较对照组明显缩短[（14．6±0．4）d 比（23．5±0．5）d，P ＜0．05]。微创组术后功能改善28例，无效1例，有效率为96．5％；对照组功能改善16例，无效10例，有效率为61．5％，微创组患者预后明显好于对照组（P ＜0．05）。结论微创血肿清除术能缩短自发性脑出血患者的住院时间，促进神经功能恢复，减少患者功能残疾，改善预后。

Objective To investigate the efficacy of minimally invasive hematoma evacuation for critical blood loss during craniotomy in patients with hypertensive cerebral hemorrhage.Meth-ods Data of 55 patients with hypertensive cerebral hemorrhage were analyzed retrospectively. Craniocerebral CT showed cerebellar supratentorial hematoma（20-30 mL）without obvious devia-tion of midline structure.Among the 55 patients,29 underwent minimally invasive surgery（mini-mally invasive group）,and 26 underwent conservative treatment（control group）.The length of hospital stay was compared between the two groups.The neurological function was evaluated by Ability of Daily Life（ADL）scoring 4 weeks after treatment.Results The length of hospital stay in minimally invasive group was significantly shorter than that in control group（（14.6 ± 0.4） days vs（23.5±0.5）days,P 〈0.05）.In minimally invasive group,neurological function was im-proved in 28 patients（96.5%）,and was not changed in 1 patient.In control group,neurological function was improved in 16 patients（61.5%）,and was not changed in 10 patients.Compared with control group,the prognosis was significantly improved in minimally invasive group（P 〈0.05）.Conclusion Minimally invasive hematoma evacuation can shorten hospital stay,promote neural functional recovery,reduce functional disability and improve prognosis in patients with hy-pertensive cerebral hemorrhage.