小骨窗开颅加尿激酶治疗高血压脑出血

A clinical study of minimal invasive operation coalesced with urokinase to eliminate hematomas of the hypertensive cerebral hemorrhage

目的 探讨微创小骨窗血肿清除加用尿激酶溶解血肿治疗高血压脑出血的效果。方法 将 32例入院的高血压脑出血病例在头颅CT片指导下行颞部直切口 ,小骨窗 2 0～ 3 0cm ,直视下吸除大部血肿 ,活动性出血予以电凝止血。血肿腔放置硅胶管 ,手术后 3d引流管注入 1万U尿激酶 ,再引流陈旧溶解的血肿液 ,并与大骨瓣开颅血肿清除术的效果相比较。结果 32例中 ,18例完全恢复 ,半自理 8例 ,优良率 81 3% ,偏瘫 4例 ,无植物生存 ,死亡 2例 ,病死率 6 %。与前期大骨瓣开颅血肿清除术相比较有良好的效果。结论 小骨窗微创血肿清除加尿激酶血肿腔溶解血肿的结合 ,最佳化地发挥了各自的优势 ,同时避免了其缺点。

Objective To explore the effects of minimal invasive operation(small bone-window penestration) and urokinase on hypertensive cerebral hemorrhage.Methods Directed by the patients'skull CT,32 cases are operated on using the minimal invasive operation with incisions measuring only 2.0～3.0cm long.Most hematoma was sucked out liquid direct vision and active bleeding was treated with electric coagulatio,and silica gel tube was put in hematoma cava;after 3 days of the operation,10000U urokinase were injected in hematom cava by drain pipe;meanwhile obsolete and dissolve hematom under was drained out.Then comparison between the minimal invasive operation and the general operation was performed.Results Among the 32 cases,2 cases died,and the fatality rate was 6%.18 cases completely recovered and 8 cases were semi-self-cared.Excellent rehabilitation rate was 81.3%.4 cases were in hemiplegia,and no patient was in persistent vegetative state.Conclusion The minimal invasive operation coalesced with urokinase to dissolve and eliminate hematoma exert their respective superiorities,while avoid their shortcomings.