高血压脑出血内外科治疗研究进展

Research progress of internal medicine and surgical treatment of hypertensive intracerebral hemorrhage

高血压脑出血(HICH)是由于高血压病患者脑小动脉在血压骤升时破裂所致。HICH常累及脑内动脉、静脉或毛细血管,脑血管破裂形成脑血肿对丘脑、小脑等造成压迫,导致患者出现剧烈疼痛、呕吐及不同程度的意识障碍。此外,较大的血肿压迫还可能导致患者肢体瘫痪、肢体感觉障碍及脑积水等严重并发症。HICH的高发病率、高致残率及高致死率对人们的生命健康造成了严重威胁,对HICH患者采取有效的治疗手段显得非常重要。在临床抢救过程中,根据患者的临床表现和脑内出血量的多少采取的治疗原则也有所不同。针对出血量少形成血肿较小的患者可采取内科保守治疗;而出血量较大的患者尽早采取外科手术清除血肿,去除对丘脑、小脑及神经的压迫,从而有效防止严重并发症的产生,也利于患者术后病情的恢复。本文通过查阅文献总结近年来HICH内外科治疗方法,以便于为患者提供更好的治疗,同时也为临床医生提供治疗借鉴依据,确保HICH患者得到及时抢救,提高生活质量。

Hypertensive intracerebral hemorrhage(HICH)is due to the rupture of cerebral arterioles during a sudden increase of blood pressure. HICH often involves internal cerebral arteries,veins or capillaries;cerebrovascular rupture froms the cerebral hematoma,which causes compression on the thalamus and cerebellum,resulting in severe pain,vomiting and different degrees of consciousness disorders. In addition,large hematoma compression may also lead to severe complications such as limb paralysis,limb sensory disorder and hydrocephalus. High incidence,high disability rate and high mortality of HICH pose serious threats to life and health,and it is very important to take effective treatment for patients with HICH.In the process of clinical rescuse,the treatment principles adopted according to the clinical manifestations of patients and the amount of intracerebral hemorrhage are also different. For patients with small amount of bleeding froming small hematoma,medical conservative treatment can be taken,while patients with large amount of bleeding can take surgical operation to remove the hematoma as soon as possible and remove the compression on thalamus,cerebellum and nerve,so as to effectively prevent the occurrence of serious complications and facilitate the recovery of patients’ condition after operation. This article summarizes the internal medicine and surgical treatment methods of HICH in recent years by consulting the literature,so as to provide better the treatment for patients,and also provide the treatment basis for clinicians,and ensure the timely rescue of HICH patients,improve the quality of life.