高血压壳核出血的超早期微创治疗

Minimal invasive therapy at the super-early stage of the hypertensive putaminal hemorrhage

目的评价应用微创血肿碎吸和大剂量尿激酶溶解引流,超早期治疗高血压壳核出血的临床效果。方法依据CT定位,采用YL—1型一次性使用颅内血肿粉碎穿刺针钻颅血肿碎吸、大剂量尿激酶溶解引流,超早期治疗高血压壳核出血32例。结果血肿基本清除2d 5例,3 d 19例,7d 8例。对侧肢体瘫痪6 h内好转4例,3 d内明显恢复11例,3周内明显好转19例。3个月后ADL分级:ADL I级8例,ADL Ⅱ级10例,ADL Ⅲ级8例,ADL Ⅳ级1例,ADL V级1例。死亡4例,死亡率为12.5％。结论应用微创血肿碎吸、大剂量尿激酶溶解引流,超早期治疗高血压壳核血血具有脑损伤轻微、操作简便、起效快、手术时间短、并发症少及费用低的特点,它弥补了开颅手术和保守治疗的不足,便于在基层医院推广应用。

Objective To evaluate the clinical effects of applying the minimally invasive technique to break and aspirate the hemorrhage, with dissolution and drainage of the putaminal hemorrhage by use of large dosage of urokinase in treating patients with the putaminal hemorrhage at the super-early stage. Methods Following localization by the computed tomography (CT) scan, 32 patients who suffered from putaminal hemorrhage at the super-early stage were treated by disposable perforating needle YL-1 to drill the skull and pump the broken hematoma by dissolution and drainage with urokinase. Results The hematoma almost disappeared in 5 cases after 2 days, 19 cases after 3 days and 8 cases after 7 days. 4 patients paralyzed at the opposite limbs got better in 6 hours; 11 cases recovered obviously in 3 days; 19 got better in 3 weeks. Activities of Daily Living (ADL) after three months was performed to find that 8 cases were in ADL-I, 10 cases ADL-II, 8 cases ADL- III, 1 case ADL-IV and 1 case ADL- V . 4 patients died, with the mortality 12.5 %. Conclusion This method has a lot of advantages such as slight injury, simple and convenient operation, short time, few complications and low expenditure. It overcomes the disadvantages of skull incision and conservative treatments, easy to be popularized in the junior hospitals.