不同方法治疗高血压脑出血的效果分析  

Analysis of curative effect of different treatments methods on suprateentovial hypertensive intracerebral hemorrhage

作　　者：张光亮[1] 徐忠烨[1] 马颖[1] 程远[1] 

机构地区：[1]重庆医科大学附属第二医院神经外科,重庆400010

出　　处：《中国临床神经外科杂志》2012年第3期129-132,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨不同方法治疗高血压脑出血（HICH）的临床效果。方法2005年4月至2011年4月收治幕上HICH（出血量20-100m1）患者214例，根据血肿量及治疗方法不同进行分组；将84例小血肿（20-30m1）患者分为钻孔引流组（n=36）和保守治疗组（n=48），57例中等血肿（31-60m1）患者分为钻孔引流组（n=31）和开颅手术组（n=26），73例大血肿（61-100m1）患者分为钻孔引流组（n=37）和开颅手术组（n=36）。对比分析各组住院期间并发症发生率、再出血率和治疗后3周和6个月GCS、GOS、13常生活能力Barthel指数（BI）和死亡率等。结果钻孔引流组并发症发生率、再出血率和死亡率与其相对应的对照组比较均无明显差异（P〉0．05）；钻孔引流术均能显著提高小和中等血肿患者近期（治疗后3周）神经功能改善率、BI和GOS评分及远期（治疗后6月）的BI和GOS（P〈0．05），而对大血肿患者预后改善不明显（P〉0．05）。结论钻孔引流术有助于小、中等血肿的HICH患者早期神经功能改善，促进其恢复，改善其预后；但是对大血肿患者伴脑疝形成或病情进展迅速、再出血明显者，建议首选以降低颅内压为目的开颅血肿清除＋去骨瓣减压术。Objective To explore the curative effect of different methods on supratentorial hypertensive intracerebral hemorrhage （SHIH）I Methods The volumes of the hematomas ranged from 20 to 30 ml in 84 patients with SHIH, who were divided into minimally invasive treatment （trephination and drainage） group A （n=36） and conservative treatment group （n=48）. The volume of the hematomas ranged from 31 to 60 ml in 57 patients with SHIH, who were divided into minimally invasive treatment group B （n=31） and eraniotomy group A （n=26）. The volume of the hematomas ranged from 61 to 100 ml in 73 patients with SHIH, who were divided into minimally invasive treatment group C （n=37） and craniotomy group B （n=36）. The rates of the complications and rebleeding on dishcharge from hospitaland the curative effects including GCS, GOS, Barthel index （B!） of activities of daily living and mortality 3 weeks and 6 months after the treatment were analyzed. Results There was no significant difference in the rate of complications, rebleeding rate and mortality between each minimally invasive treatment group and the corresponding control group （P〉0.05）. The rate of improvement of the neurological function 3 weeks after the treatment and GOS and BI 3 weeks and 6 months after the treatment were significantly better in the minimally invasive treatment group A and B respectively than that in the conservative treatment group and craniotomy group A （P〈 0.05）. There was insignificant difference in the curative effects between minimally invasive treatment group C and craniotomy group B （P〉0.05）. Conclusion The minimally invasive surgery was beneficial to the improvements of the prognosis in patients with small and

关 键 词：高血压脑出血 钻孔引流术 开颅血肿清除术 保守治疗 疗效 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]