CT定位微创治疗高血压脑出血脑疝患者疗效分析

Curative effect evaluation of CT-guided minimal invasive treatment for cerebral hernia caused by hypertensive cerebral hemorrhage

目的探讨CT定位微创抽吸注入尿激酶引流脑内血肿治疗高血压脑出血脑疝的短期临床疗效。方法回顾性分析35例脑出血脑疝患者微创穿刺血肿清除术,CT定位,YL-1型颅内血肿穿刺针抽吸引流,并用生理盐水反复冲洗,术后血肿腔内注入尿激酶。患者术前格拉斯哥昏迷评分(GCS)、血肿量、发病距手术时间、血肿清除率和出院时的生存情况。结果出院时意识状况:神清4例,浅昏迷7例,中度昏迷3例,深昏迷4例,死亡8例,死亡率22.9%,8例中6例死于脑干功能衰竭,1例死于肺炎,1例死于再出血。另外9例因放弃治疗而死亡,总死亡17例。存活18例中,随访出院后3个月GOS评分优良率27.8%。结论微创抽吸注入尿激酶引流脑内血肿术治疗高血压脑出血脑疝患者,创伤小,时间短,及时缓解了脑疝,为抢救患者赢得宝贵时间,提高了患者的生存率。

Objective The short-term outcomes of CT-guided needle suction and administration of urokinase for intracerebral hematomas were investigated. Methods A total number of 35 patients with cerebral hemorrhage and cerebral hernia who underwent CT-guided needle puncture to remove the hematoma were analyzed retrospectively.YL-1 type intracranial hematoma puncture needle suction and drainage system were used. After irrigating the intracerebral hematoma with normal saline repeatedly,urokinase was administered into the hematoma. Pre-operative Glasgow coma scale（GCS）,hematoma volume,operation time,hematoma clearance rate and the outcome of the treatment were recorded. Results There were 4 patients recovered with consciousness,7 with mild coma,3 with moderate coma,4 with severe coma and 8 died. The death rate was 22. 9%. Among the deaths,6 died from failure of the brainstem,1 from pneumonia and the last one from re-hemorrhage. Besides,9 patients died from abandoning further treatment. After 3 months＇ follow-up,27. 8% of the survivors were evaluated as good according to the GOS.Conclusion CT-guided needle suction,urokinase administration and drainage of the intracerebral hematoma for cerebral hernia from hypertensive cerebral hemorrhage can shorten the operation time and improve the survival rate.