自发性小脑出血昏迷程度较深患者手术干预价值的临床研究  

The clinical study of surgical treatment value to the deep coma patients with spontaneous cerebellar hemorrhage

作　　者：陈祖鹏[1] 张昕[1] 李徐[1] 

机构地区：[1]浙江中医药大学附属第一医院神经外科,杭州310006

出　　处：《中国医师进修杂志》2016年第7期614-617,共4页Chinese Journal of Postgraduates of Medicine

基　　金：浙江省中医药科技计划（2014ZB040）

摘　　要：目的：探讨自发性小脑出血昏迷程度较深患者手术治疗的价值。方法分析43例小脑出血并且格拉斯哥昏迷量表（GCS）评分≤5分患者的临床资料，其中32例采取手术治疗（手术治疗组），11例采取保守治疗（保守治疗组）。治疗后6个月采用格拉斯哥预后量表（GOS）进行疗效评价。结果治疗后6个月，手术治疗组病死率为31.25%（10/32），保守治疗组病死率为6/11，两组病死率比较差异无统计学意义（χ2＝1.04，P＝0.310）。手术治疗组结局不良（GOS评分1～3分）率为75.00%（24/32），保守治疗组结局不良率为11/11，两组结局不良率比较差异无统计学意义（χ2＝2.40，P＝0.120）。大于60岁的患者，手术治疗组与保守治疗组结局良好（GOS评分4～5分）率比较差异无统计学意义（5/16比0，χ2＝6.00，P＝0.060）。结论虽然手术治疗病死率较低，但未经评估脑干功能而直接手术不能改善GCS评分≤5分的小脑出血患者的远期预后。Objective To investigate the surgical treatment value to the deep coma patients with spontaneous cerebellar hemorrhage. Methods The clinical manifestations were recorded and analyzed in 43 patients suffering from cerebellar hemorrhage. Thirty-two patients（surgical treatment group） were treated with suboccipital decompression, clot evacuation and external ventricular drainage, and 11 patients （conservative treatment group） were managed conservatively. The level of consciousness was evaluated with Glasgow coma scale （GCS）, and GCS scores of all enrolled patients was less than 5. Outcome was assessed with Glasgow outcome scale （GOS） at 6 months after onset. Results At 6 months after onset, the fatality rate in surgical treatment group was 31.25%（10/32）, in conservative treatment group was 6/11, and there was no significant difference （χ2=1.04, P=0.310）. The rate of bad outcome （GOS 1-3 scores） in surgical treatment group was 75.00%（24/32）, in conservative treatment group was 11/11, and there was no significant difference （χ2=2.40, P=0.120）. In the patients of more than 60 years old, the rate of good outcome between surgical treatment group and conservative treatment group had no significant difference：5/16 vs. 0,χ2=6.00, P=0.060. Conclusions Although fatality rate is lower, the long-term prognosis couldn′ t be improved by surgical treatment in the cerebellar hemorrhage patients with GCS≤5 scores when the brainstem function isn′t evaluated.

关 键 词：脑出血 创伤性 昏迷 外科手术 保守治疗 

分 类 号：R651.12[医药卫生—外科学]