基层医院高血压脑出血个性化微创治疗的临床研究

Clinical study on individualized minimally invasive treatment of hypertensive intracerebral hemorrhage in primary hospital

目的探讨基层医院高血压脑出血各种微创手术方式的临床效果。方法选择符合微创手术适应证的56例高血压脑出血患者,根据不同患者采取个性化手术方式(软通道穿刺、硬通道穿刺、锁孔显微镜下血肿清除、小骨窗内镜下血肿清除、立体定向血肿穿刺抽吸引流术等)进行微创手术,观察疗效。结果56例患者术后再出血4例,再出血率7.14%。随访3~6个月,采用日常生活能力(ADL)评定:Ⅰ级8例、Ⅱ级17例、Ⅲ级24例、Ⅳ级2例、V级1例、死亡4例(包括3例因经济及对预后不良难以接受原因放弃治疗),恢复良好率87.50%,死亡率7.14%。结论基层医院高血压脑出血患者因发病时间短等情况有其特殊性,对符合手术适应证的不同患者采取个性化的微创手术方式进行干预,使得取得良好预后成为可能。

Objective To investigate the clinical effects of various minimally invasive surgical procedures for hypertensive intracerebral hemorrhage in primary hospitals.Methods A total of 56 patients with hypertensive intracerebral hemorrhage were selected.According to the different patients,the micro-invasive operation was performed by the individual operation methods(soft-channel puncture,hard-channel puncture,hematoma clearance under the keyhole microscope,hematoma clearance under the small bone window endoscope,stereotactic aspiration and drainage of hematoma,etc.).The effect was observed.Results Rebleeding occurred in 4 of 56 patients,the rebleeding rate was 7.14%.The patients were followed up for 3-6 months and assessed by activities of daily living(ADL):8 cases were gradeⅠ,17 cases were gradeⅡ,24 cases were gradeⅢ,2 cases were gradeⅣ,1 case was grade V,4 cases died(including 3 cases who gave up treatment because of poor economy and difficult to accept poor prognosis).The recovery rate was 87.50%,and the mortality rate was 7.14%.Conclusion The patients with hypertensive intracerebral hemorrhage in grass-roots hospitals have their own characteristics because of the short time of attack when they come to the hospital.It is possible to achieve a good prognosis by taking individualized micro-invasive surgical intervention to different patients who meet the operation indication.