手术治疗自发性小脑出血深昏迷患者的预后相关因素分析  

Prognostic factors of surgical treatment for deep coma patients after spontaneous cerebeHar hemorrhage

作　　者：高忠恩[1] 岑庆君[1] 李莉霞[1] 冯荣亮[1] 黎海滨[1] 张鹏[1] 

机构地区：[1]广东省肇庆市第一人民医院神经外科,526021

出　　处：《中华神经医学杂志》2012年第7期741-743,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨手术治疗自发性小脑出血深昏迷患者的必要性以及影响治疗效果的因素。方法回顾性分析广东省肇庆市第一人民医院神经外科2002年3月至2012年1月收治的23例因自发性小脑出血导致深度昏迷患者的临床资料，将接受手术治疗的18例患者按预后分为2组，分析其治疗效果及预后影响因素。结果预后较好组与预后差组患者发病后至接受手术的时间差异有统计学意义（P=0．023），2组患者间年龄、血肿量大小及住院时间差异无统计学意义（P〉0．05），2组患者并发脑积水、环池受压程度及呼吸循环紊乱差异亦无统计学意义（P〉0．05）。结论自发性小脑出血患者发病后迅速发展至深昏迷不是手术禁忌证，及时的手术解除脑干受压是降低自发性小脑出血患者病死率的关键因素。Objective To investigate the therapeutic influencing factors for surgical treatment of deep comatose patients after spontaneous cerebellar hemorrhage. Methods The clinical data of 23 patients in deep coma due to spontaneous cerebellar hemorrhage, admitted to our hospital lYom March 2003 to January 2012, were studied retrospectively. Eighteen patients received surgical treatment were divided into 2 groups depending on their different prognoses; the therapeutical effect and their prognostic factors were analyzed. Results The interval between onset of symptom and operation in patients having favorable outcome was significantly shorter than that in patients with unfavorable outcome （P= 0.023）. No significant differences on age, hospitalization time, hematoma size, presence of obstructive hydrocephalus, obliteration of perimesencephalic cistern and presence of cycle respiration were noted between the 2 groups. Conclusion Deep coma is not a contraindication for surgery in very recent onset patients after spontaneous cerebellar hemorrhage and immediate surgical relief of brain stem compression is the most important factor for reduction mortality in patients with spontaneous cerebellar hemorrhage.

关 键 词：小脑 脑出血 昏迷 手术 预后 

分 类 号：R651.1[医药卫生—外科学]