108例自发性脑出血患者超早期手术治疗的体会  

Experience of excess-early surgical treatment in spontaneous intracerebral hemorrhage with 108 patients

作　　者：薛中南[1] 

机构地区：[1]浙江省湖州市中心医院神经外科,313000

出　　处：《临床神经外科杂志》2005年第4期157-160,共4页Journal of Clinical Neurosurgery

摘　　要：目的 探讨自发性脑出血患者的手术疗效、治疗方式及其对预后生存质量的影响.方法 108例脑内出血(幕上≥30 ml、幕下≥15 ml),发病6 h内手术68例(62.97%),6～72 h内手术30例(27.77%),72 h后手术10例(9.25%).血肿清除+颞肌下减压(或去骨瓣)47例,血肿清除+颞肌下减压(或去骨瓣)+脑室外引流(尿激酶血肿溶解)16例;单纯一侧或双侧脑室穿刺引流尿激酶血肿溶解术45例.结果 存活80例(74.18%),按ADL分级:Ⅰ级11例,Ⅱ级7例,Ⅲ级39例,Ⅳ级20例,Ⅴ级为3例.死亡28(25.92%)例.结论 把握好手术时机,尽早手术清除血肿,能够有效缓解急性颅内压增高症状,阻断因血肿急性脑膨胀而形成的颅内高压、脑血流量下降、脑组织缺血缺氧等一系列恶性循环,是患者脑出血抢救治疗成功的关键.同时,提高手术质量,减少手术创伤,对于降低患者的死亡率、预防术后并发症、争取好的预后都具有重要意义.Objective To explore the operational effectiveness,way of treatment and influence to prognosis in patients with spontaneous intracerebral hemorrhage. Methods Of 108 cases with intracerebral hemorrhage （ supratentorial hemorrhage ≥30 ml, subtontotial ≥ 15 ml） ,68 cases（62.97% ） were operated in 6 hours, 30 cases （27.77%） were operated between 6 to 72 hours, and l0 cases（9.25% ） were operated in excess of 72 hours after illness. Clearance of intracerebral hematoma and subtemporal decompression （or following craniotomy） were 47 cases, clearance of intracerebral hematoma and subtemporal decompression（ or following craniotomy ） and ventricular drainage （ urokinase solution hematoma） were 16 cases, single or bilateral ventricular drainage were 45 cases. Rusults 80 survived （ 74.18% ）. According to ADL ll cases was in grade Ⅰ , 7 in grade Ⅱ , 39 in grade Ⅲ, 20 in grade Ⅳ, 3 in grade Ⅴ and 28 （ 25.92% ） was died. Conclusions Excess-early operation in clearance of intracerebral hematoma could block acute brain swelling in consequence of hematoma, increased intracranial pressure, cerebral bloold flow descent, cerebral tissue ischemia, hypoxia at a series of vicious circle. Abatement increased intracranial pressure was the key of success in had treated on cerebral hemorrhage with patients. In addition notice operational way, decrease operative wound to decrease mortality in patients, prevent from postoperative complication be possessed of important implication for favorable prognosis.

关 键 词：自发性脑出血 超早期手术治疗 颞肌下减压 血肿清除 

分 类 号：R743.34[医药卫生—神经病学与精神病学]