高血压丘脑出血破入脑室89例患者临床救治分析  

Clinical treatment of 89 cases with hypertensive thalamus hemorrhage broken into cerebral ventricles

作　　者：史克珊[1] 高宁[1] 

机构地区：[1]海口市人民医院神经外科,570208

出　　处：《中国急救医学》2009年第2期151-153,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨微创手术辅以尿激酶溶解引流治疗高血压丘脑出血破入脑室的疗效。方法采用小骨窗开颅联合脑室穿刺外引流、微创丘脑血肿穿刺联合脑室穿刺外引流、单纯脑室穿刺外引流，以及术后辅以尿激酶溶解治疗89例丘脑出血破入脑室患者。结果小骨窗开颅联合脑室穿刺外引流患者40例，出现术后并发症28例，死亡5例；微创血肿穿刺抽吸联合脑室穿刺外引流患者20例，出现术后并发症11例，死亡2例；单纯双侧脑室穿刺外引流29例，出现术后并发症16例，死亡3例。术后日常生活能力（ADL）分级：I级14例；Ⅱ级27例；Ⅲ级25例；Ⅳ级8例；V级5例；VI级10例。结论采用微创手术辅以尿激酶溶解引流治疗高血压丘脑出血破入脑室的患者，具有创伤小，操作简便，手术时间短，术中出血少，安全有效的特点。可以降低病死率和病残率，提高患者的生存质量。Objective To evaluate the effectiveness of minimally invasive surgery with the use of urokinase to liquefy and drain intracerebral hematoma for hypertensive thalamus hemorrhage broken into cerebral ventricles. Methods 89 patients with thalamus hemorrhage broken into the ventricle were treated with small bone flap craniotomy, ventricular puncture and external drainage; minimally invasive thalamus hematoma puncture, ventricular puncture and external drainage; simple cerebral ventricle puncture and external drainage; postoperative urokinase to liquefy hematoma. Results 40 patients accepted small bone flap craniotomy, ventricular puncture and external drainage, 28 cases had post - operative complications, and five cases died. 20 cases were treated with minimally invasive thalamus hematoma puncture, ventricular puncture and external drainage, 11 cases had post - operative complications, and 2 cases died ; simply bilateral cerebral ventricles puncture and external drainage were performed for 29 cases, 16 cases had post - operative complications, and 3 cases died. Postoperative patients ADL classification; I grade was 14 cases; II grade 27 cases; m grade 25 cases; 1V grade 8 cases; Vgrade 5 cases; VI grade 10 cases. Conclusions The use of minimally invasive surgery and postoperative urokinase to liquefy and drain hematoma for the patients of hypertensive thalamus hemorrhage broken into the ventricle with the charac-teristics of less trauma and simple, short operation time, less bleeding, safety and effectiveness can reduce mortality and disability rate, and improve the life quality of patients.

关 键 词：小骨窗开颅 微创血肿穿刺抽吸 脑室外引流 丘脑出血 脑室出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.15[医药卫生—临床医学]