大骨瓣开颅术治疗重症高血压脑出血的疗效分析  

Effectiveness analysis on large bone craniectomy for severe hypertensive hemorrhage

作　　者：耿锋 张志文 杨非 查伟光 赵飞 查智健 李光照 陆昌燕 GENG Feng;ZHANG Zhi-wen;YANG Fei(Department of Neurosurgery,Hefei First People's Hospital Group South District Binhu Hospital,Hefei 230000,China)

机构地区：[1]安徽省合肥市滨湖医院神经外科,合肥230000 [2]中国人民解放军总医院第四医学中心神经外科

出　　处：《临床神经外科杂志》2019年第3期273-276,共4页Journal of Clinical Neurosurgery

基　　金：国家国际科技合作项目(2011DFA30550)

摘　　要：目的探讨大骨瓣开颅术在重症高血压脑出血治疗中与单纯开颅血肿清除术的疗效比较。方法选取安徽省合肥市滨湖医院2014年1月—2018年11月手术治疗的66例高血压脑出血患者。根据患者的病情分为开颅血肿清除+大骨瓣减压组(去骨瓣组,骨窗减压范围至少为10 cm×12 cm)和单纯开颅血肿清除组(单纯开颅组,小骨窗开颅血肿清除)。术后1个月时进行格拉斯哥预后量表(Glasgow outcome scale,GOS)评分,比较两种手术患者的近期疗效。结果去骨瓣组恢复良好(GOS评分4~5分)、恢复较差(GOS评分2~3分)、死亡的患者分别为12例(36.4%)、16例(48.5%)、5例(15.1%);单纯开颅组分别为16例(48.5%)、7例(21.2%)、10例(30.3%)。两组间预后的差异有统计学意义(χ^2值17.28,P=0.000 2)。结论单纯血肿清除术对重症高血压脑出血的减压效果不显著。而大骨瓣减压术与其相比,则能取得较好的效果,可明显降低重症高血压脑出血的死亡率。Objective To explore curative effect of large bone flap craniectomy in the treatment of severe hypertensive cerebral hemorrhage(HCH)compared with other surgical methods.Methods 66 patients with HCH underwent surgery from January 2014 to November 2018 were selected in Binhu Hospital of Hefei City,Anhui Province.According to the patient's situation and condition,they were divided into hematoma removal+big bone flap craniectomy decompression groups(de-bone flap group,bone window decompression range is at least 10 cm×12 cm)and pure craniotomy hematoma removal group(simple craniotomy group,small bone window craniotomy hematoma clearance).Glasgow outcome scale(GOS)scores were performed after 1 month postoperatively to compare the short-term outcomes of the two surgical patients.Results The group of decompression well recovered(GOS score 4-5),poor recovered(GOS score 2-3),and the patients died were 12(36.4%),16(48.5%),and 5(15.1%).The simple craniotomy group were 16 cases(48.5%),7 cases(21.2%),and 10 cases(30.3%).The difference in prognosis between the two groups was statistically significant(χ^2 value 17.28,P=0.0002).Conclusions The effect of simple hematoma evacuation on decompression of severe hypertensive cerebral hemorrhage is not sufficient.Compared with large bone flap decompression,it can achieve better results and significantly reduce the mortality of severe hypertensive cerebral hemorrhage.

关 键 词：重症高血压脑出血 手术治疗 大骨瓣减压术 小骨窗减压术 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学]