脑出血微创伤治疗的临床研究  

The study of application of minimal invasive surgical techniques on patients with cerebral hemorrhage

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

机构地区：[1]成都军区总医院神经内科,四川成都610083

出　　处：《实用医院临床杂志》2009年第3期52-54,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨微创伤清除术对脑出血的治疗效果。方法选择头颅CT证实为脑出血患者480例,随机分为颅内血肿微创清除术组（微创组）248例和内科保守治疗组（保守组）232例,分别采用颅内血肿微创清除术和内科保守治疗,对两组患者治疗后神经功能缺损情况、日常生活能力Barthel指数（BI）的临床评分、总有效率以及血肿的清除吸收情况进行比较。结果微创治疗的248例患者,治愈84例,明显好转103例,好转40例,无变化7例,14例死于并发症,总有效率91.5%;保守组232例患者,治愈38例,明显好转52例,好转67例,无变化29例,死亡46例,总有效率67.6%,两组总有效率比较差异有显著性意义（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,差异均有显著性意义（P〈0.05）。治疗7天后,微创组中234例患者血肿为（14.43±5.77）ml,保守组186例患者血肿为（30.77±4.43）ml,差异有显著性意义（P〈0.01）。结论颅内血肿微创清除术是一种安全、适用于颅内中、大量出血且疗效较好的一种方法,术后患者生存质量明显优于保守组;病情平稳患者颅内血肿最佳穿刺时间为发病后6-24小时,有脑疝形成的危重患者可超早期（发病后6小时内）穿刺治疗。Objective To investigate the treatment effect of the minimal invasive drainage on senile patients with cerebral hemorrhage.Methods 480 patients with cerebral hemorrhage confirmed by CT scanning were randomly divided into minimal invasive groups（n = 248） and conservative treatment groups（n = 232）.The distinguish markers were placed bilaterally on the same location of the skull、CT scanning and YL-1 model needle were applied to the patients.The neurological deficient scale and the ability of daily activity（BI index）、total efficiency rate、the hematoma absorptive rate at the pre-and post-treatment in both group of the patients were compared.Results Except 14 cases die of the complications and 7cases of ineffective,the other patients（n = 227） in minimal invasive surgery obtained satisfactory treatment（full-recovered： 84 cases,obvious recovery： 103 cases,effective： 40 cases） with a total efficiency rate of 91.5%.46 cases die of the complications and 29 cases of ineffective,other patients（n = 158） in conservative treatment group were recovered（full-recovered： 38 cases,obvious recover： 52 cases and effective： 67 cases） with a total efficiency rate of 67.6%（P 〈 0.01）.Seven days after treatment,the volume of hematoma were reduced to be（14.43±5.77）ml（n = 234） and（30.77±4.43）ml（n = 186） respectively（P 〈 0.01）.Three days after treatment,the neurological deficient and BI scale in minimal invasive group were better than the conservative group.Conclusions It is obvious that the minimal invasive surgery showed extra benefit compared with that of the conservative treatment.Best timing is about 6～24 hours after hemorrhage in the cases with stable condition.Severe ill patients with herniation of brain should be treated in time（within 6 h）.The minimal invasive surgery was a safe and effective method for cerebral hemorrhage.

关 键 词：脑出血 微创伤治疗 治疗时间窗 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R45[医药卫生—临床医学]