高血压脑出血微创穿刺术围手术早期预防再出血策略

The strategy of prevent rehaemorrhagia in the early perioperative period of minimally invasive puncture treatment for hypertension cerebral hemorrhage

目的探讨高血压脑出血(HICH)微创穿刺术围手术早期(从决定手术至术后24 h内)预防再出血的策略和安全性。方法对绵阳富临医院神经外科2004年3月至2014年12月233例高血压脑出血病例在微创穿刺术围手术早期采取两种不同的策略预防再出血,对比二者的再出血率、死亡率。结果两组患者的出血部位及出血量差异均无统计学意义(P>0.05)。策略一组的117例患者再出血33例,占28.20%,死亡37例,占31.62%;策略二组的116例患者再出血10例,占8.62%,死亡15例,占12.93%,策略二组的再出血率和死亡率均低于策略一组,差异有统计学意义(P<0.01)。结论高血压脑出血微创穿刺术围手术早期术中全麻+术后镇痛镇静的策略平稳安全,可以降低再出血率和死亡率。

Objective To explore strategies to prevent rehaemorrhagia in early perioperative period （from when decide to operate to 24 h after operating ） of microinvasive craniopuncture scavenging treatment for hypertensive intracerebral hemorrhage. Methods 233 patients with hypertensive intracerebral hemorrhage were treated with microinvasive craniopuncture scavenging techniquein Department of Neurosurgery,Mianyang Fulin Hospital from March 2004 to December 2014. Two different strategies were taken to prevent rehaemorrhagia. Rehaemorrhagia rate and mortality of both strategies were compared. Results For patients using the strategy one,33 cases rehaemorrhagia occured, accounting for 28.20%, 37 cases of death, accounting for 31.62%. For strategy two, 10 cases rehaemorrhagia occured and 15 cases of death, accounting for 12.93%.The differences between the two groups were statistically significant. Rehaemorrhagia rate and mortality rate of the strategy two were lower than those of strategy one. Conclusion To prevent rehaemorrhagia in earlier perioperative period of microinvasive craniopuncture scavenging technique for hypertensive intracerebral hemorrhage treatment, the strategy of general anesthesia with trachea cannula in operation ＋ postoperative analgesia and sedation was smooth and safe, and could reduce the rate of rehaemorrhagia and mortality.