多点锥颅治疗高血压性脑出血  

Treatment of hypertensive cerebral hemorrhage by drilling drainage through multiple holes

作　　者：赵卫忠[1] 朱明霞[1] 高觉[1] 周祺[1] 姚澄[1] 许辉[1] 徐舒[1] 刘盛屹[1] 

机构地区：[1]南京中医药大学附属常州中医院神经外科,常州213003

出　　处：《中国微创外科杂志》2007年第7期659-660,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨多点锥颅抽吸引流治疗高血压性脑出血的疗效。方法 根据CT不同的出血量采用不同数量的靶点在局麻下进行锥颅抽吸、尿激酶灌注冲洗引流治疗高血压性脑出血67例。结果 住院死亡22例（32.8%）,其中4例术后3 d内由于脑干功能衰竭死亡,12例术后合并肺部感染、上消化道出血死亡,6例术后血肿扩大、改行开颅术后死亡。余45例随访10～12个月,以ADL为疗效指标,1级5例,2级9例,3级14例,4级8例,5级3例;随访期间死亡6例,其中2例死于颅内再次出血,3例合并肺部感染死亡,1例死因不明。结论 多点锥颅治疗高血压性脑出血,效果满意,尤其适用于出血量较大或年老体弱不能适于开颅手术者。Objective To evaluate therapeutic effects of drilling drainage through multiple holes for hypertensive cerebral hemorrhage. Methods Under local anesthesia, drilling craniotomy through multiple holes and urokinase irrigation and drainage were performed in 67 cases of hypertensive cerebral hemorrhage. The number of holes was determined by estimated hemorrhagic volume under CT scanning. Results Twenty-two cases （32.8%） died in hospital, including 4 cases because of brain stem function failure within 3 days after operation, 12 cases because of pulmonary infection and upper gastrointestinal bleeding, and 6 cases following an open craniotomy for hemorrhage enlargement. The remaining 45 cases were followed up for 10 - 12 months. On the basis of the Activity of Daily Living （ADL） evaluation, there were 5 cases of grade Ⅰ , 9 cases of grade Ⅱ , 14 cases of grade Ⅲ , 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ diseases. During the follow-up visits there were 6 fatal cases. Among them 2 cases died of re-bleeding, 3 cases died of pulmonary infection, and 1 case succumbed to unknown causes. Conclusions Drilling drainage through multiple holes for the treatment of hypertensive cerebral hemorrhage is effective. The procedure is suitable for massive hemorrhage or elderly patients that are contraindicated to open craniotomy.

关 键 词：高血压 脑出血 锥颅 

分 类 号：R651.1[医药卫生—外科学]