影响高血压脑出血立体定向排空术预后的相关因素分析  

Analysis of the relevant elements of therapeutic effect of stereotactic evacuation on hypertensive cerebral hemorrhag

作　　者：杨先清[1] 刘塑敏 范家权 

机构地区：[1]安徽省六安市中医院脑外科,六安237006

出　　处：《立体定向和功能性神经外科杂志》2008年第5期293-295,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的分析影响立体定向排空术治疗高血压脑出血患者预后的因素。方法总结2002年2月～2007年12月收治的76例高血压脑出血患者采用立体定向排空术的临床资料,结合随访资料进行分析,确定影响预后的主要因素。结果术后再出血9例,其中丘脑5例(3例破入脑室),基底节区4例,有脑疝形成4例,均为发病12h内手术,再出血死亡计7例;颅内感染3例;肺部感染10例,2例死亡;应急性消化道溃疡出血5例,1例死亡。超早期手术、血肿部位、血肿破入脑室是术后再出血的主要危险因素。术后出院前共死亡10例,占13.2%,其中有脑疝形成者术后共计死亡7例(包括随访病例),占死亡人数的46.7%,脑疝、再出血、血肿部位、坠入性肺部感染、应急性消化道溃疡出血是患者术后死亡的主要影响因素。结论立体定向排空术治疗高血压脑出血,应正确选择手术时机,防止再出血、坠入性肺部感染和应急性消化道溃疡出血,以改善高血压脑出血患者的预后。Objective To analyze the relevant elements affecting therapeutic effect of stereotactic evacuation on hypertensive cerebral hemorrhage. Methods To summarize the clinical data of 76 cases with hemorrhage stereotactic evacuation, from February 2002 to December 2007,To determine the main factors affecting the prognosis by analyzing the follow-up data. Results Rehemorrhage after operation, 9 cases, among which 5 cases of rehemorrhage are in the thalamen-eephalon, 4 cases of rehemorrhage are in the basal ganglia and 4 cases of rehemorrhage result in cerebral hernia. All the above cases have operation within 12 hours after the outbreak of the disease. After operation, there are 7 cases of death resulted from after--operation rehemorrhage; 3 cases of encephalic infection; 10 cases have infection in lung, among which 2 cases of death; 5 cases suffer from emergency gastrointestinal bleeding, among which 1 case of death. The ultra-early surgery, hematoma site, and breaking into the ventricle hematoma are the main dangerous factors. The total amount of death is 10 cases after operation before they discharged hospital, accounting for 13. 2%, of which 7 cases （including follow--up eases） have already affected cerebral hernia died, accounting for 46.7 % of the number of deaths. Cerebral hernia, bleeding, Hematoma site, penetrating pulmonary infection, emergency gastrointestinal bleeding ulcer patients after death are the main factors which can account for the death of the operation. Conclusion In order to prevent further bleeding penetrating into the lung infection and emergency digestive ulcer bleeding. Operation time should be selected correctly by employing stereotactic evacuation on the hypertensive cerebral hemorrhage. Thus the prognosis of patients with cerebral hemorrhage can be greatly improved.

关 键 词：立体定向 高血压脑出血 外科治疗 

分 类 号：R743.34[医药卫生—神经病学与精神病学]