颅内血肿微创清除术在高血压脑出血治疗中的应用价值

Clinical role of mini invasion removal of intracerebral hematoma in treatment of hypertensive cerebral hemorrhage

目的 通过比较开展颅内血肿微创清除术前后高血压脑出血住院病人病死率的变化 ,分析颅内血肿微创清除术在治疗高血压脑出血中的临床应用价值。方法 按照开展颅内血肿微创清除术前后将病人分为两组 :1995年 1月～ 1997年 12月为Ⅰ组 ,所有病例常规保守治疗 ;1998年 1月～ 2 0 0 2年 5月为Ⅱ组 ,病人除常规内科治疗外 ,其中 77例行颅内血肿微创清除术治疗。比较两组住院总病死率、危重病人病死率的变化 ,评价微创手术是否对住院病人总病死率及危重病人的病死率有明显改善。结果 Ⅰ组住院总病死率为 2 6 4% ,出血量 3 0ml以上的病死率为 80 % ,其中大于 70ml的病死率为10 0 % ;Ⅱ组住院总病死率为 17 3 % ,出血量 3 0ml以上的病死率为 2 8 2 % ,大于 70ml的病死率为 44 4%。危重病人的病死率Ⅱ组明显低于Ⅰ组 ,有显著差异 (P <0 0 1)。总病死率Ⅱ组虽然低于Ⅰ组 ,但无显著差异 (P >0 0 5 )。结论 颅内血肿微创清除术可以大大降低高血压脑出血住院危重病人的病死率 ,是一种值得推广应用的治疗手段。

Objective To analyze the clinical value of mini invasion removal method of intracerebral hematoma for treatment of hypertensive cerebral hemorrhage by comparing the death rate in the patients undertaking mini invasion removal and those who did not receive the operation.Methods The patients were divided into two groups according to whether the method was used or not:conservative group consisting of the patients hospitalized from January,1995 to December,1997,the mini invasion method group made up of the patients hospitalized between January,1998 and May,2002. In the second group, all patients received the conventional treatment,and 77 of them were treated at the same time with mini invasion removal method for intracerebral hematoma. The total death rate and death rate of critical patients between the two groups were compared in order to evaluate mini invasion removal method for intracerebral hematoma.Results The total death rate in group Ⅰwas 26 4%,but the death rate of the patients with volume of hematoma larger than 30 ml was 80%,whereas when hematoma volume was over 70 ml the death rate went up to 100%. In the mini invasion method group,the total death rate was 17 3%,those with 30 ml of hematoma volume had 28 2% of death rate,when hematoma volume was over 70 ml the death rate was 44 4%. The critical patients' death rate in group Ⅱ was significantly lower than group Ⅰ. There was a significant difference between the two groups ( P <0 01). The total death rate in group Ⅱlooked lower than group Ⅰ,but it was not significantly different ( P >0 05).Conclusions Mini invasion removal method for intracerebral hematoma could greatly reduce death rate in treatment of hypertensive cerebral hemorrhage. It was a very good method, being worth popularizing.