高血压基底节区出血并脑疝58例治疗分析

Treatment analysis of hypertensive basal ganglia hemorrhage concomitant with cerebral hernia in 58 cases

目的探讨开颅血肿清除并去骨瓣减压术治疗基底节区脑出血并脑疝的效果。方法 58例基底节区脑出血并脑疝患者采用开颅血肿清除并去骨瓣减压术治疗,术后给予控制血压、预防感染、脱水及补液等综合治疗,必要时行气管切开及腰椎穿刺术。结果术后6个月,根据ADL评分:Ⅰ级1例(1.72%),Ⅱ级20例(34.48%),Ⅲ级17例(29.31%),Ⅳ级7例(12.06%),Ⅴ级7例(12.06%),死亡6例(10.34%)。结论开颅血肿清除并去骨瓣减压术可有效的降低病死率,提高患者生存质量,可作为脑疝患者的首选手术方式。

Objective To investigate the effect of craniotomy evacuation of hematoma jointing de-compressive craniotomy on patients with hypertensive basal ganglia hemorrhage complicated with cerebral hernia.Methods 58 patients with hypertensive basal ganglia hemorrhage and cerebral hernia received craniotomy evacuation of hematoma and de-compressive craniotomy,after operation,all of whom were treated with comprehensive therapy including controlling blood pressure,preventing infection,giving dehydration and fluid infusion.And patients received tracheotomy and lumbar puncture if necessary.Results After 6months,according to ADL grade system,1case(1.72%)reached to grade I,20cases(34.48%)to grade II,17cases(29.31%)to III,7cases(12.06%)to grade IV,7cases(12.06%)to grade V and finally 6cases(10.34%)died.Conclusion The craniotomy evacuation of hematoma combined with de-compressive craniotomy can obviously decrease the mortality and enhance the activity of daily living,which should be considered as prior choice to cure cerebral hernia.