小骨窗开颅显微镜下血肿清除术治疗高血压脑出血的临床研究  

Clinical study on the treatment of hypertensive intracerebral hemorrhage by small bone window craniotomy hematoma removal under microscope

作　　者：白亮 刘宝华[2] 

机构地区：[1]浙江省象山县第一人民医院神经外科,浙江象山315700 [2]温州医学院附属第二医院神经内科,浙江温州325000

出　　处：《中国现代医生》2015年第18期37-40,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划(2013RCA036)

摘　　要：目的探讨小骨窗开颅显微镜下血肿清除术治疗高血压脑出血的疗效。方法选取2012年6月~2014年6月在我院治疗的80例高血压脑出血患者作为观察对象,均行头颅CT确诊,排除单侧或双侧瞳孔散大、中线移位非常明显者。全部患者根据手术方法不同随机分为观察组（n=40）和对照组（n=40）,两组患者围手术期均予降低颅压、控制血压、抗感染、维持水电解质平衡等常规治疗。对照组行大骨瓣开颅术,观察组行小骨窗开颅显微镜下血肿清除术,比较两组患者的平均手术时间、术中出血量、术后住院时间、两组患者术后并发症情况,同时对两组患者的日常生活能力进行评定。结果观察组患者的平均手术时间、住院时间均显著短于对照组,观察组患者的术中出血量显著少于对照组,差异具有统计学意义（P〈0.05）。观察组无一例出现肺部感染、再出血、水电解质紊乱,术后并发症发生率为5.0%,显著低于对照组的30.0%,差异有统计学意义（P〈0.05）。观察组日常生活能力评定显示Ⅰ级完全恢复日常生活占50.0%,对照组为30.0%。观察组患者日常生活能力预后显著优于对照组,差异有统计学意义（P〈0.05）。结论小骨窗开颅显微镜下血肿清除术治疗高血压脑出血疗效确切,且手术时间短,出血少、并发症少,能够显著改善患者的日常生活能力,值得推广和应用。Objective To investigate the effect of the small bone window craniotomy hematoma microscope under surgical in treatment of hypertensive cerebral hemorrhage. Methods From June 2012 to June 2014 in our hospital, selected 80 cases of hypertensive cerebral hemorrhage patients as the observation object, were diagnosed by head CT, excluding unilateral or bilateral mydriasis, midline shift very obvious. All patients according to the different methods of operation were randomly divided into observation group（n=40） and control group（n=40）, two patients with peri operation period to reduce the intracranial pressure, control blood pressure, anti infection, maintain water electrolyte balance and other conventional treatment. The control group underwent craniotomy with large bone flap, the observation group for small bone window craniotomy evacuation of hematoma, average operation time, bleeding volume, postoperative hospitalization time, complications of patients were compared after treatment between two groups, at the same time for two groups of patients assessed the ability of daily life. Results The average operation time, hospitalization time in the observation group was significantly shorter than that in the control group, the bleeding in the observation group was sig nificantly less than that in the control group, with statistically significant difference（P 〈0.05）. The observation group without pulmonary infection, bleeding, electrolyte disturbances the incidence of postoperative complications was 5.0%, significantly lower than the control group 30.0%, the difference was statistically significant（ P〈0.05）. The daily life ability evaluation of the observation group showed that I level completely resumed daily life rate 50.0%, while the control was 30.0%, The ability of daily life prognosis in the observation group was better than the control group, with significant difference（P〈0.05）. Conclusion Under the microscope by small bone window craniotomy evacuation of hematoma in treatment of hyperten

关 键 词：高血压脑出血 小骨窗开颅显微镜下血肿清除术 日常生活能力 并发症 

分 类 号：R651.1[医药卫生—外科学]