微创手术结合高压氧治疗高血压脑出血的临床研究  

Clinical study of minimally invasive surgery and hyperbaric oxygen therapy for the treatment of hypertensive cerebral hemorrhage

作　　者：龚玉水 吴锡春[2] 姜学高[1] 吴传菁 黄友基[1] 叶建华[1] 黎建华[1] 

机构地区：[1]凉山州第一人民医院脑外科,西昌615000 [2]凉山州第一人民医院高压氧科,西昌615000

出　　处：《中华神经医学杂志》2007年第8期842-844,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨微创手术结合高压氧治疗高血压脑出血的临床效果。方法197例高血压基底节或丘脑出血的患者入院时随机分成实验组和对照组,两组患者入院后在局麻下行急诊一次性锥颅脑内血肿穿刺吸引+尿激酶溶解引流术,术后常规降血压、降颅压、止血、预防感染、脑保护、维护内环境稳定、支持等治疗,实验组患者术后第四天(术后72h)加行高压氧治疗。结果术后3d内,实验组99例死亡23例,死亡率22.2%;实验组患者术后1月时,意识障碍好转程度、GCS评分、瘫痪肢体肌力恢复、ADL分级较对照组有显著性增加(P<0.05)。结论微创手术结合高压氧是治疗高血压脑出血的有效方法之一。Objective To explore the therapeutic effects of minimally invasive surgery and hyperbaric oxygen therapy for the treatment of hypertensive cerebral hemorrhage. Methods A total of 197 patients with basilar hemorrhage or thalamic hemorrhage coursed by hypertension were randomly divided into the experimental group and control group immediately after hospitalization. All the patients were treated with emergent one-time punctured suction and drainage of vertebral and intmcranial hematomas plus lysis and drainage with urokinase under local anesthesia, and after the operation, all the patients were treated with routine hypotensive agent administration, intmcranial decompression, hemostasis, infection prevention, cerebral protection, maintenance of internal environment homeostasis and support therapy etc. The experimental group received hyperbaric oxygen therapy at the 4th day （72 h later） aider the operation. Results Within the postoperative 3 d, 23 of the 99 cases in the experiment group died, death rate being 22.2%; one month later after the operation, the improved level of conscious disturbance, Glasgow coma scale （GCS） scores, restoration of muscle strength for paralyzed limbs and activities of daily living （ADL） grade of the experimental group were markedly better than that of the control group （P〈0.05）. Conclusion The combined treatment of ＂minimally invasive surgery and hyperbaric oxygen therapy＂ is one of the most effective means for the treatment of hypertensive cerebral hemorrhage.

关 键 词：高血压脑出血 微创手术 高压氧 

分 类 号：R651.12[医药卫生—外科学]