| 摘要: |
| ［摘要］ 目的 探讨高血压脑出血外科不同手术方式和手术时机对临床疗效的影响。方法 分析278例高血压脑出血患者的临床资料，依据患者的意识状态、瞳孔改变、出血时间、出血部位、血肿量等，分别采用微创血肿碎吸术、小骨窗血肿清除术及血肿清除并去骨瓣减压术等方式进行治疗，对不同术式下的治疗效果及其适应证进行探讨，并观察手术时机对疗效的影响。结果 术后6个月随访，行微创碎吸手术81例，术后ADL评级结果良好58例，差21例，死亡2例（2.5%）；行小骨窗血肿清除术134例，术后ADL评级结果良好79例，差42例，死亡13例（9.7%）；行血肿清除并去骨瓣减压术63例，术后ADL评级结果良好23例，差28例，死亡12例（19.0%）。再进一步观察小骨窗血肿清除术134例，手术距发病（出血）时间<6 h的51例中，术后6个月ADL评级结果良好37例，差11例，死亡3例；6～24 h的37例中，良好19例，差14例，死亡4例；>24 h的46例中，良好23例，差17例，死亡6例。结论 术前根据多参数评估高血压脑出血，并选择不同的手术方式和手术时机，可提高疗效，降低死亡率。 |
| 关键词: 脑出血 手术治疗 手术方式与时机 |
| DOI：10.3969/j.issn.1674-3806.2012.10.04 |
| 分类号:R 605 |
| 基金项目:广西科技厅回国基金资助项目（编号：桂科回0342005） |
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| Effect of different surgical methods and time on the therapeutic efficacy of patients with hypertensive intracerebral hematomas |
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XIAO Quan, LIANG You-ming, CHEN Hai-jun, et al.
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Department of Neurosurgery, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021,China
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| Abstract: |
| ［Abstract］ Objective To discuss the effect of different surgical methods and time on the clinical efficacy of hypertensive intracerebral hemorrhage.Methods Retrospective analysis of the clinical data of 278 cases of hypertensive intracerebaral hemorrhage were performed; hematoma puncture aspiration, minimally-invasive craniotomy or craniectomy & decompressive surgery were respectively chosen according to the patient′s state of consciousness, papillary changes, bleeding time, the site of bleeding and hematoma volume. The treatment of different surgery approach and its indication was discussed, and the effect given by the time of surgery was observed.Results Eighty-one cases were treated with puncture aspiration, of them 58 cases had a good outcome in ADL, 21 cases were poor and 2 cases were dead(2.5%). One hundred and thirty-four case chose minimally-invasive craniotomy, of them 79 good in ADL, 42 cases poor and 13 were dead(9.7%). Sixty-three cases were treated with craniectomy & decompressive surgery，of them 23 good, 28 poor and 12 dead(19.0%). The 134 cases with minimally-invasive craniotomy were further observed，51 of them accepted surgery in less than 6 hours after haemorrhage, of them 37 had good outcome after 6 months of the surgery, 11 poor, 3 dead. In addition, 37 cases accepted the same surgery after 6 hours but less than 24 hours, of them 19 good, 14 poor and 4 dead. Besides, in the rest 46 cases who accepted surgery after 24 hours, of them 23 good, 17 poor, 6 were dead.Conclusion Choosing optimal surgical approach based on the evaluation of the intracerebral hemorrhage with multiple data and giving surgery in time can improve the effect and reduce the mortality. |
| Key words: Hypertensive intracerebral hemorrhage Surgical treatment Surgicat methods and time |
