脑出血穿刺引流术后再出血脑疝15例救治体会  

Experience in the treatment of rebleeding and brain herniation after percutaneous drainage for intracerebral hemorrhage:An analysis of 15 cases

作　　者：岳盛魁 刘浩波 潘东红 YUE Shengkui;LIU Haobo;PAN Donghong(Department of Neurosurgery,Wuxi 9th People's Hospital,Wuxi,Jiangsu 214062,China;Department of Neurosurgery,Yangquan Coal Mine General Hospital,Yangquan,Shanxi 045000,China)

机构地区：[1]无锡市第九人民医院神经外科,江苏无锡214062 [2]阳泉煤业(集团)有限责任公司总医院神经外科,山西阳泉045000

出　　处：《国际神经病学神经外科学杂志》2023年第3期12-15,共4页Journal of International Neurology and Neurosurgery

摘　　要：目的 探讨脑出血穿刺引流术后再出血脑疝患者的治疗方法及预后。方法 回顾分析2014年9月—2021年12月脑出血穿刺引流术后再出血脑疝15例患者的临床资料。结果 11例患者通过早期血肿抽吸及尿激酶溶解引流清除血肿,6个月后日常生活能力(ADL)分级,Ⅱ级4例,Ⅲ级6例,Ⅳ级1例,4例患者转为开颅血肿清除术及去骨瓣减压术,6个月后ADL分级,Ⅲ级2例,Ⅳ级1例,Ⅴ级1例。结论 早期血肿抽吸可以作为脑出血穿刺引流术后再出血脑疝患者的首选手段,病情不缓解再行开颅手术治疗。Objective To investigate the treatment and prognosis of patients with rebleeding and brain herniation after percutaneous drainage for intracerebral hemorrhage.Methods A retrospective analysis was performed for the clinical data of 15 patients with rebleeding and brain herniation after percutaneous drainage for intracerebral hemorrhage from September 2014 to December 2021.Results Among the 15 patients,11 received early hematoma aspiration and urokinase dissolution and drainage to remove the hematoma,and as for Activities of Daily Living(ADL) grade after 6 months,there were 4 patients with grade Ⅱ ADL,6 with grade Ⅲ ADL,and 1 with grade Ⅳ ADL;4 patients were converted to craniotomy for hematoma clearance and decompressive craniectomy,and as for ADL grade after 6 months,there were 2patients with grade Ⅲ ADL,1 with grade Ⅳ ADL,and 1 with grade V ADL.Conclusions Early hematoma aspiration can be used as the first choice for patients with rebleeding and brain herniation after percutaneous drainage for intracerebral hemorrhage,and craniotomy can be performed if no remission is achieved.

关 键 词：高血压脑出血 穿刺引流术 再出血 脑疝 血肿抽吸 

分 类 号：R743[医药卫生—神经病学与精神病学]