立体定向手术治疗超早期高血压性脑出血手术方法探讨  

Study of stereotactic therapy for ultra-early stage hypertensive cerebral hemorrhage

作　　者：杨川[1] 勾俊龙[1] 毛群[1] 姚庆海[1] 刘宗惠[2] 

机构地区：[1]天津市第三医院神经外科,300250 [2]解放军海军总医院神经外科,北京100037

出　　处：《中国微侵袭神经外科杂志》2013年第11期484-486,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：天津市卫生局基金课题(07KZ40)

摘　　要：目的探讨在立体定向手术治疗超早期高血压性脑出血中,减少术中血肿抽吸量和增加术后尿激酶的使用频率对再出血和预后的影响。方法采用立体定向手术治疗超早期(出血6 h内)高血压性脑出血164例,等分为Ⅰ组和Ⅱ组。Ⅰ组术中抽吸血肿量的80%;Ⅱ组仅抽吸20%,并在术后增加尿激酶的使用频率。比较两组病人术中再出血率、术后24 h再出血率、术后30 d病死率、术后30 d病侧肢体运动功能和90 d GOS评分情况。结果Ⅱ组术中再出血率和术后30 d病死率均较Ⅰ组明显降低(P<0.05),而两组术后24 h再出血率、30 d病侧肢体肌力和90 d GOS评分差异无统计学意义(P>0.05)。结论超早期高血压性脑出血采用立体定向手术治疗时,减少术中血肿抽吸量、增加术后尿激酶使用频率能降低病人的术中再出血率及术后病死率。Objective To discuss the influence of reducing the volume of hematoma aspiration preoperatively and increasing the frequency of using urokinase postoperatively on rebleeding and prognosis in stereotactic therapy for ultra-early hypertensive cerebral hemorrhage. Methods One hundred and sixty-four patients with hypertensive intracerebral hemorrhage at ultra-early stage （bleeding within 6 h） were equally divided into group I and group 11. 80 percent of hematoma volume was aspirated in group I , and 20 percent in group I1, with increase of the frequency of using urokinase after operation. The rebleeding rate during and 24 h after the operation, mortality rate 30 d after the operation, motor fimction of the paralytic limb 30 d after the operation and GOS score 90 d after the operation were compared between the two groups. Results Compared with group I , the intraoperative rebleeding rate and mortality rate 30 d after operation were obviously decreased in group I1 （P 〈 0.05）, however, there were no significant differences between the two groups in rebleeding rate 24 h after the operation, motor function of the paralytic limb 30 d after the operation and GOS score 90 d after the operation （P 〉 0.05）. Conclusions It can reduce the intraoperative rebleeding rate and postoperative mortality rate to reduce the volume of hematoma aspiration preoperatively and increase the frequency of using urokinase postoperatively during stereotactic therapy for ultra-early hypertensive cerebral hemorrhage.

关 键 词：颅内出血 高血压性 立体定位技术 引流术 尿纤溶酶原激活物 

分 类 号：R651.1[医药卫生—外科学]