高血压脑出血的规范化微创外科治疗  

作　　者：魏增华[1] 续继军[1] 李永涛[1] 赵逢玲[1] 吴超[1] 张守满 丁鑫 马璇 

机构地区：[1]滕州市中心人民医院,山东滕州277500 [2]枣庄矿务局医院

出　　处：《山东医药》2003年第21期14-16,共3页Shandong Medical Journal

基　　金：国家"十五"科技攻关课题 ( No.2 0 0 1BA70 3 B18)

摘　　要：目的　探讨高血压脑出血 (HICH)的规范化外科治疗。方法　制定 HICH入选标准 ,将患者随机分为小骨窗开颅血肿清除术组 (小骨窗组 )和颅骨钻孔血肿清除术组 (颅骨钻孔组 ) ,观察两组患者的术后 GCS评分、临床神经功能缺损评分变化 ,并进行疗效评价。结果　 HICH发病后早期 (8～ 2 4小时 )尤其是 12小时内手术者 ,术后再出血发生率高。 GCS6～ 8分者小骨窗组的病死率及致残率比颅骨钻孔组低 ,而 GCS9～ 15分者以颅骨钻孔组的病死率及致残率较低。结论　 HICH发病后 ,经内科保守治疗病情稍稳定 ,血压控制在 180 /10 5 mm Hg内 ,12～ 2 4小时内手术效果好 ;GCS6～ 8分者首选小骨窗开颅血肿清除术 ,GCS9～Objective To explore the standardise surgery method in patients with hypertensive intracerebral hemorrhage(HICH) Methods 60 patients with HICH were randomly divided into two groups according to the style of hematoma evacuation,namely key hole group and sphenotresia haematoma craniotomy group Norms of enrolling,excluding and operation type were established,treatment effects were appreciated by investigating the patients GCS after operation and observing the change of clinical nerve function defaulting grade in eapoplexy patients Results The rate of aftertreatment re hemorrhage was high in HICH patients who operated in early phase(8～24 hours),especially with in 12 hours The mortal rate and deformity rate of patients whose GCS score 6～8 in key hole group were lower than that in sphenotresia haematoma craniotomy group otherwise,the two rates of patients whose GCS score 9～15 in sphenotresia hematoma craniotomy were lower than that in key hole one Conclusions The operation effect is better in patients whose blood pressure is controlled below 180/105 mmHg within 12～24 hours with medicine treatment The patients of GCS score 6～8 should be prefered to key hole,and sphenotresia haematoma craniotomy should be the first choice of GCS score 9～15 patients

关 键 词：高血压脑出血 规范化 微创外科 治疗 手术方式 

分 类 号：R651.12[医药卫生—外科学]