225例自发性脑出血血肿微创清除术近期疗效的研究

Early curative effects in 225 patients with spontaneous intracerebral hemorrhage treated by stereotactic catheter drainage

目的 探讨自发性脑出血血肿微创清除术的近期疗效及其对术后 30天病死率的影响。方法 采用CT定向、电脑模拟纸坐标定位、旋转式手钻锥颅、微管碎吸的方法清除血肿 ,监测术前及术后各时相点的颅内压、格拉斯哥昏迷评分积分的动态变化 ,观察 30天实际与预测病死率、并发症和神经影像学变化。结果 全组 30天的预测病死率为 5 8 2 6 % ,实际病死率为 2 0 89% ,差异极其显著 (P <0 0 0 1)。术前平均血肿容积为 (41 4± 12 8)ml,术后为 (14 9± 4 3)ml,差异极其显著 (P <0 0 0 1)。结论 脑血肿微创清除术有显著降低自发性脑出血病死率作用 ,但其术后并发症却降低了其应有的疗效。

Objective To study the early curative effects and 30-day mortality in patients with spontaneous intracerebral hemorrhage treated with stereotactic catheter drainage.Methods We used CT localization,computer simulated orientation,manual skull drill and microcatheter suction to clear away intracerebral hematoma.We measured the dynamic changes of intracranial pressure (ICP),Glasgow-Pittsburgh coma scale(GCS) before operation and various time points after operaton.30-day mortality was compared with predicted 30-day mortality obtained by using of a previously validated method. Complications and the changes of heuro imagings were also monitored.Results The actual mortality (20 89%)within 30 days,was very singnificantly lower( P <0 001)than predicted mortality(58 26%) of these patients.The mean volume of hematome(14 9±4 3)ml after operation was very significantly lower( P <0 001) than before operation(41 4±12 8)ml in these patients.Conclusion This stereotactic catheter drainage can significanly decrease the mortality of patieuts with spontaneous intracerebral hemorrhage,but the post opercctive complications decrease the expected curative effects .In the future,we should put the emphasis of the study on the prevention and cure for the complications of this operation. [