高血压脑出血患者手术治疗及血压控制情况随访观察  

Surgical treatment of hypertensive cerebral hemorrhage and blood pressure control follow-up study

作　　者：杨江河[1] 李华[1] 郑刚[1] 依力哈木[1] 

机构地区：[1]兰州军区乌鲁木齐总医院神经外科,新疆乌鲁木齐830000

出　　处：《中国现代医药杂志》2011年第11期8-10,共3页Modern Medicine Journal of China

摘　　要：目的分析手术方法治疗高血压脑出血的疗效及术后血压控制情况。方法对2007~2010年在我院接受手术治疗的高血压脑出血患者211例病例资料进行分析并对术后血压控制情况进行随访观察。结果术后24～72h复查CT,血肿完全清除46例,90%以上清除104例,60%～90%清除26例,清除不足60%为丘脑出血破入脑室者35例。211例患者中未出现术后再出血,术后并发症有肺部感染15例,消化道出血17例,急性肾功能衰竭3例。术后4周,恢复良好120例,中度残废42例,重度残废37例,死亡12例（术前脑疝、合并心肌梗死、2型糖尿病）,术后1月死亡率5.69%。术后对患者进行降压治疗健康教育,术后3个月、6个月随访中,达标率不高,在随访中不断对患者进行高血压相关知识宣教,嘱患者坚持规律服用药物,在术后1年及2年随访中,达标率逐渐提高。后2年随访中,所有患者未再出现脑出血,通过康复功能治疗后,中度残废59例,重度残废20例。结论高血压脑出血外科治疗应选择最佳术式,结合显微操作技术,清除血肿,减少脑组织损伤,减少并发症。手术治疗脑出血是重要手段,但手术后患者长期血压控制达标对于改善患者预后及预防再次脑出血更为重要,作为外科医生在对手术患者随访的同时,进行血压情况的随访同样重要。Objective To analyze the method of operation in treatment of hypertensive cerebral hemorrhage the curative effect and postoperative follow up observation on blood pressure control. Methods From 2007 to 2010 in our hospital operation in treatment of hypertensive cerebral hemorrhage patients clinical data for analysis and on postoperative blood pressure control were observed. Results After 24~72h review of CT, hematoma were totally removed in 46 cases, more than 90% removal in 104 cases, 60% to 90% 26 cases, less than 60% for the thalamus hemorrhage in 35 cases. In 211 patients without postoperative bleeding, postoperative complications, pulmonary infection in 15 cases, hemorrhage of digestive tract in 17 cases, 3 cases with acute renal failure. 4 weeks after operation, 120 patients recovered well, moderate disability in 42 cases, severe disability in 37 cases, 12 cases died （preoperative cerebral hernia, complicated by myocardial infarction, diabetes mellitus type 2）, postoperative mortality for january was 5.69%. Postoperative patients were given hypotensive treatment of health education, after 3 months, 6 months follow-up, success rate was not high, in the follow-up of patients with hypertension continue to gave knowledge related to the mission, adhere to the laws that patients taking the drug, after 1 year and 2 years of follow-up, compliance rate increased gradually. After 2 years of follow-up, all patients did not appear again in cerebral hemorrhage, through the rehabilitation treatment, moderate disability in 59 cases, severe disability in 20 cases. Conclusion Surgical treatment of hypertensive intracerebral hemorrhage, select the best technique, combined with microsurgical technique, removal of the hematoma, reduction of brain tissue injury to reduce complications. Operation treatment of intracerebral hemorrhage is an important means, but after the operation the patient long-term blood pressure control standards to improve patient prognosis and prevention of cerebral hemorrhage again is more important,

关 键 词：高血压脑出血 手术治疗 血压 随访 

分 类 号：R651.1[医药卫生—外科学]