高血压性脑内血肿致病特点与手术对策  

The pathopoiesia characteristic and surgical countermeasures of hypertensive hematoma

作　　者：杨应明[1] 

机构地区：[1]汕头大学医学院第一附属医院神经外科,广东汕头515041

出　　处：《中华神经医学杂志》2003年第3期177-179,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨重型高血压性脑出血颅内病理生理特点与手术对策。方法将501例重型(即意识障碍Ⅲ～Ⅴ级,必须马上手术者)高血压性脑出血按手术方式分为三组。A.常规开颅手术组298例、B.钻孔引流组83例和C.皮层锁孔显微直视手术组120例.进行回顾研究,对其手术后再出血率及死亡率作统计学对照分析;结合重型高血压性脑出血致病情恶化的颅内病理生理特点,选择手术对策。结果三组再出血率分别为30％(89例),21.3％(18例)和0％(0例);手术死亡率为20.2％(60例),21.9％(18例)和0.8％(1例)。A组与B组在再出血率与手术死亡率方面差异均无统计学意义P>0.05,A组与B组,分别与C组在再出血率与不良率方面差异均有显著统计学意义P<0.001。结论重型高血压性脑出血致病情恶化的颅内病理生理改变,可归纳为三个基本要素:脑受压、颅高压与再出血。手术时机延误是导致效果不良(植物生存或死亡)的主要因素,常规开颅手术与钻孔引流术除了各有其相应的手术指征之外,还有助于赢得采用皮层锁孔显微直视手术治疗的时机。皮层锁孔显微直视术是治疗重型高血压脑内血肿的最佳手术方法;可有效阻断上述三方面因素,解除脑受压、降低颅内压及制止出血的再发生;是高血压脑出血形成血肿时采用手术治疗的最佳选择。Objective To study encephalic pathophysiology characteristics and surgical countermeasures of severe hypertensive cerebral hemorrhage. Methods 501 cases of severe hypertensive cerebral hemorrhage with COS of III-V levels were divided into 3 groups based on the surgical approaches . In group A, craniotomy was performed for a total number of 298 cases; In group B, borehole drainage was conducted for 83 cases; in group C, 120 received the microsurgery of cortical keyhole. By way of retrospective research of all the cases, the rates of postoperative re-hemorrhage and mortality were statistically analyzed. The surgical approaches were selected combined with the pathophysiological characteristics of severe hypertensive cerebral hemorrhage. Results The re-hemorrhage rates in the 3 groups were 30 % (89 cases), 21.3 % (18 cases) and 0 % ( 0 case) respectively and the mortality rates 20.2 % (60 cases), 21.9 % (18 cases) and 0.8 % (1 case) respectively. The re-hemorrhage and mortality rates between group A and group B were insignificantly different in statistics (P>0.05) but those between group A/group B and group C significantly in statistics (P<0.001). Conclusion The encephalic pathophysiological changes may owe to three basic factors of the serious hypertensive cerebral hemorrhage: encephalothlipsis, intra-cranial high pressure and re-hemorrhage. Missing operation opportunities resulted in minus therapeutic effects (vegetable or even death). General craniotomy and borehole drainage are conducive to winning the opportunity for cortices keyhole microsurgery, the best surgical method to treat severe hypertensive intracerebral hematoma through the cortices keyhole under the microscope. By diminishing encephalothlipsis, relieving intracranial pressure and stopping occurrence of re-hemorrhage, cortices keyhole microsurgery claims to be the best operative method for intracranial hematoma caused by hypertensive cerebral hemorrhage.

关 键 词：高血压性脑内血肿 锁孔手术 显微手术 手术治疗 临床资料 

分 类 号：R651.12[医药卫生—外科学]