高血压脑出血早期凝血功能异常患者不同手术方式疗效比较  

Therapeutic effect of different surgical modalities for hypertensive intracranial hemorrhage with blood coagulation defect at early stage

作　　者：顾水均[1] 卢明[1] 宣宏飞[1] 谢仁龙[1] 司赟[1] 董伟峰[1] 严肖峰[1] 张俊[1] 陈新治[1] 罗静泳[1] 

机构地区：[1]杭州市萧山区第一人民医院神经外科,萧山区第二人民医院311201

出　　处：《浙江医学》2008年第4期309-310,共2页Zhejiang Medical Journal

基　　金：杭州市科技局重点专病专项课题(2005633Q25)

摘　　要：目的探讨高血压脑出血(HICH)早期凝血功能异常患者不同手术方式的选择及疗效差异。方法回顾性分析早期发现凝血功能异常的65例脑出血手术患者,根据术式不同分为小骨窗血肿清除引流组(小骨窗组,38例)与微创穿刺碎吸引流组(微创组,27例),计算两组间血肿再发率、恢复率、重残率与病死率,并进行对比分析。结果微创组血肿再发、重残及死亡发生率(14.8%、22.2%、7.4%)均明显低于小骨窗组(39.5%、31.6%、23.7%),差异均有统计学意义(均P<0.05),而恢复率(70.4%)则明显高于小骨窗组(44.7%),差异亦有统计学意义(P<0.05)。结论对于HICH早期凝血功能异常的患者,采取微创穿刺碎吸合并尿激酶冲洗引流简捷、创伤小,可有效减少二次血肿的发生,有利于改善患者预后。Objective To investigate the therapeutic effect of various surgical treatment for hypertensive intracranial hemorrhage （HICH） with blood coagulation defect at the early stage. Methods Sixty five HICH patients with blood coagulation defect at the early stage were treated with drainage with craniotomy and clearance of hematoma （group A, n=38） or drainage with minimally invasive puncture （group B, n=37）, respectively. The incidence rate of secondary hematoma, recovery rate, disability rate and mortality rate were retrospectively analyzed and compared between two groups. Results The rate of second hematoma, the disability rate and mortality rate in group B were significantly lower than those in group A （14.8% vs 39.5%, 22.2% vs 31.6%, 7.4% vs 23.7%, all P〈0.05）; meanwhile, the recovery rate in group B was significantly higher than that in group A （ 70.4% vs 44.7%, P〈0.05）. Conclusion In the early stage of HICH with disturbance of blood coagulation, drainage after minimally invasive puncture can reduce the incidence of secondary hematoma and improve prognosis of patients.

关 键 词：高血压脑出血 凝血功能 手术 疗效 

分 类 号：R651[医药卫生—外科学]