高血压脑出血合并脑疝患者45例救治分析  

Analysis of the treatment of patients with hypertension cerebral Hemorrahage and brain hernia

作　　者：张爱新[1] 王才永[1] 

机构地区：[1]北京市平谷区医院神经外科,101200

出　　处：《中国医疗前沿》2010年第2期61-62,共2页China Healthcare Innovation

摘　　要：目的探讨微创穿刺术联合开颅血肿清除去骨瓣减压术对高血压性脑出血合并脑疝患者的临床治疗价值。方法对2005年1月～2009年1月我科收治的45例高血压性脑出血合并脑疝患者,首先利用YL-1型一次性使用颅内血肿粉碎穿刺针(以下简称YL-1型针)进行血肿微创穿刺急救,建立硬通道,清除颅内部分血肿,然后全麻下行开颅血肿清除去骨瓣减压术(微创+开颅组)。结果术后6月至1年随访,按GCS预后评分评估疗效,与2000年1月～2004年1月收治的高血压性脑出血合并脑疝患者行开颅血肿清除去骨瓣减压术治疗的60例(单纯开颅组)患者进行对比,微创+开颅组总体死亡率下降(χ2=4.70,0.01<p<0.05),预后良好率显著提高(χ2=8.57,p<0.01)。结论早期血肿微创穿刺术联合开颅血肿清除去骨瓣减压术能够降低高血压脑出血合并脑疝患者的致死率和致残率,提高治疗效果。Objective To explore the clinical effect of evacuation of hematoma by way of the combination of microinvasive craniopuncture and craniotomy on patients with hypertension cerebral hemorrahage and brain hernia. Methods 45 cases with hypertension cerebral hemorrahage and brain hernia which were hospitalised from 2005.1 to 2009.1 were treated as follows： The hypertension cerebral hemorrahage patient was partly drained through microinvasive craniopuncture with YL-1 puncture needle as first aid treatment. Then the patient was removed through craniotomy.Results At 6 to 12 month follow-up, Glasgow outcome scale showed that overall mortality dropped by 24.44%（x^2=4.70,0.01 〈 p〈0.05）and the rate of favourable outcome increased by 48.89 % （x^2=8.57,p〈0.01）, in comparison with that of the patients who were given routine removal of nematoma during the period of 2000.1 to 2004.1. Conclusion The combination of microinvasive craniopuncture and craniotomy has good effect on patients with hypertension cerebral hemorrahage and brain hernia. It can reduce the mortality and improve curative effect.

关 键 词：高血压脑出血 脑疝 微创穿刺术 

分 类 号：R743.2[医药卫生—神经病学与精神病学] R743.34[医药卫生—临床医学]