老年脑出血患者颅内血肿微创伤治疗的临床研究  

The study of minimally invasive surgery in elderly patients with cerebral hemorrhage

作　　者：吴渝宪[1] 王庆松[1] 王伟文[1] 林杭[1] 曹仁存[1] 王云霞[1] 张德琼[2] 

机构地区：[1]成都军区总医院,成都610083 [2]四川省金堂县第一人民医院

出　　处：《中华老年心脑血管病杂志》2008年第7期524-526,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨微创清除术对老年脑出血患者的治疗效果。方法选择经头颅CT证实为脑出血患者450例,随机分为颅内血肿微创清除术组(微创组,236例)和内科保守治疗组(保守组,214例)。微创组采用双侧头皮相应部位安放标记物,螺旋CT导向定位,YL-1型颅内血肿穿刺针对脑出血患者进行穿刺治疗,并对两组患者治疗前后神经功能缺损评分、日常生活能力Barthel指数(BI)评分、病死率、并发症发生率以及血肿的清除吸收情况进行比较。结果微创组总有效率为91.1%,保守组为67.8%,两组疗效比较差异显著(P<0.01)。微创组、保守组治疗前血肿体积为(50.47±9.23)ml和(51.88±10.33)ml;治疗7天后,微创组、保守组血肿体积为(14.65±5.36)ml和(29.52±4.38)ml,微创组血肿吸收速率明显快于保守组(P<0.01)。治疗3天后,微创组神经功能缺损评分低于保守组,BI评分明显高于保守组。结论颅内血肿微创清除术是一种安全、适用于老年患者颅内中等量和大量出血且疗效较好的一种方法。Objective To investigate the efficacy of the minimally invasive drainage in treatment of elderly patients with cerebral hemorrhage. Methods 450 patients with cerebral hemorrhage confirmed by CT scanning were randomly divided into minimally invasive surgery group （n = 236） and conservative treatment group （n = 214）. The distinguishing markers were put at the corresponding sites of two sides of the skull,CT scanning and YL-1 type needle were applied to the minimally invasive surgery for puncture treatment of cerebral hemorrhage. Before and after treatment,the neurological deficiency score, the ability of everyday activity,the complications,mortality rate and the hematoma obsorption rate in the 2 groups were compared. Results In minimally invasive surgery group,except 14 cases who died of the complications and 7 ineffective cases,the other patients obtained satisfactory treatment results （full recovery in 82 cases,obvious recovery in 101 cases,improvement in 32 cases） ,with a total effective rate of 91.1%. In conservative treatment group,43 cases died of the complications and 26 cases were ineffective,other patients recovered （full recovery in 37 cases,obvious recovery in 49 cases and improvement in 59 cases） ,with a total effective rate of 67. group was（50.47±9.23） 8%. Before treatment, the volume of hematoma in minimally invasive ml and in conservative treatment group was （51.88±10.33） ml. Seven days after treatment,the volume of hematoma reduced to （14. 65±5.36） ml and （29.52±4. 38） ml respectively. Three days after treatment, the neurological deficiency score and BI index in minimally invasive surgery group were better than those in the conservative treatment group. Conclusion The minimally invasive surgery is a safe and effective method for cerebral hemorrhage.

关 键 词：脑出血 外科手术 微创性 血肿 穿刺术 

分 类 号：R651.12[医药卫生—外科学]