三种方法治疗中等量高血压性脑壳核出血的效果比较

Comparison of three methods in treating moderate hypertensive putamne hemorrhage

目的 探讨中等量 (2 0～ 30 m l)高血压性脑壳核出血的内、外科治疗效果。方法 对 6 0例中等量高血压性脑壳核出血的患者 ,采取传统保守治疗、钻孔血肿引流术和骨窗开颅血肿清除术 3种方治疗案 ,观察比较临床疗效。结果 治疗 1个月后评价临床疗效 ,保守组 2 0例 ,神经功能缺损评分 (NHS)减少 (10 .95± 1.2 3)分 ,显著进步 4例 ,进步 16例 ;钻孔组 2 1例 ,NHS减少 (13.95± 1.2 0 )分 ,显著进步 18例 ,进步 3例 ;骨窗组 19例 ,NHS减少 (14.16± 1.42 )分 ,显著进步 15例 ,进步 4例。钻孔组和骨窗组的疗效比较无显著性差异 (P>0 .0 5 ) ,两组疗效均明显优于保守组 (P<0 .0 0 1)。结论 对于中等量高血压性脑壳核出血 ,应积极考虑手术治疗的必要性 ,CT导向钻孔血肿引流术是首选术式。

Objective To investigate the medical and surgical treatment of moderate hypertensive putamen hemorrhage (20～30 ml).Methods Three kinds of treatment, including conservative treatment, drainage of hematoma by sphenotresia and elimination of hematoma by enlarging sphenotresia, were applied to 60 cases of moderate hypertensive putamen hemorrhage. The clinical effects were examined.Results The clinical effects were assessed after 1 month of treatment. Neurological Handicap Scale (NHS) of the conservative group(20 cases)decreased by (10.95±1.23) points, among which 4 cases were rated as significant progress and 16 cases as progress.NHS of the sphenotresia group(21 cases) decreased by (13.95±1.20) points, among which 18 cases were rated as significant progress and 3 cases as progress. NHS of the enlarging sphenotresia group (19 cases)decreased by (14.16±1.42) points, among which 15 cases were rated as significant progress and 4 cases as progress. The clinic effects had no significant difference between the sphenotresia group and the enlarging sphenotresia group (P>0.05). The two groups had better effects than the conservative group (P<0.001). Conclusions Surgical operation should be taken into account for treatment of moderate hypertensive putamen hemorrhage. Drainage of hematoma by sphenotresia under CT is the primary choice.