高血压相关性脑干出血的治疗探讨  

Treatment of hypertensive brainstem hemorrhage

作　　者：李浩[1] 刘文科[1] 林森[1] 游潮[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《中华神经外科杂志》2013年第4期339-341,共3页Chinese Journal of Neurosurgery

基　　金：国家十二五科技支撑计划项目课题（2011BA108B05）

摘　　要：目的探讨高血压脑干出血的治疗策略、适应证和手术指征。方法回顾性分析77例高血压脑干出血患者的临床资料，比较不同病情的高血压脑干出血患者治疗方式及疗效。结果77例患者中，中脑出血25例，脑桥出血33，延髓出血19例。手术治疗22例；保守治疗55例。以CT示脑干出血最大层面面积占该层面脑干面积的百分比分组，小血肿组（≤50％）43例，大血肿组（〉50％）34例；小血肿组均为保守治疗；大血肿组中手术治疗22例，均为开颅手术清除血肿，保守治疗12例。治疗期间保守治疗病死率20．0％（11／55）；手术病死率18．2％（4／22）；小血肿组病死率4．7％（2／43）；大血肿组病死率38．2％（13／34），两组病死率比较差异有统计学意义（P〈n05）；大血肿组手术治疗病死率18．2％（4／22）明显低于保守治疗病死率75．0％（9／12），两种治疗方式比较差异有统计学意义（P〈n05）。结论对于出血量小（≤50％）的患者首选保守治疗；出血量大（〉50％）的患者手术治疗组疗效及预后明显优于非手术治疗组，正确掌握脑干出血的手术指征，能有效降低病死率。Objective To study the treatment strategies and surgical indications of hypertensive brainstem hemorrhage. Methods A retrospective analysis of the clinical data in 77 cases with hypertensive brainstem hemorrhage （HBH） from January 2010 to January 2012 in West China Hospital of Sichuan University was carried out. The treatment and efficacy between the different levels of groups of HBH were compared. Results Of the 77 patients,25 hemorrhage located in the midbrain, 33 in the pans and 19 in the medulla oblongata. 22 patients underwent surgery ;55 patients received conservative treatment. According to percentage of the maximum level of brainstem hemorrhage area and the brainstem area, there were 43 patients in small hematoma group （≤50%）,and 34 cases in large hematoma group （ 〉 50% ）. In small hematoma group, all cases received conservative treatment ;In large hematoma group, 22 patients received eraniotomy to remove the hematoma, and conservative treatment of 12 cases.The mortality of conservative treatment during the hospitalization was 20. 0% （11/55）;and mortality of surgical treatment waslS. 2% （4/22）. The mortality of small hematoma group was 4. 7% （2/43） ;large hematoma was 38. 2% （13/34）. The difference of two groups had statistical significance （ P 〈 0. 05 ）. In large hematoma group, the mortality of surgical groupl8. 2% （4/22） was significantly lower than conservative group75.0% （9/12） （ P 〈 0. 05 ）. Conclusions Patients with small hematoma （≤50% ） of HBH preferred the conservative treatment. The efficacy and prognosis of surgical treatment were significantly better than conservative treatment in large hematoma group （ 〉 50% ） . Follow the surgical indication for HBH,it can effectively reduce the mortality of HBH.

关 键 词：高血压 脑干出血 治疗 

分 类 号：R651[医药卫生—外科学] R544[医药卫生—临床医学] R74