超早期小骨窗开颅治疗高血压脑出28例分析.DOCVIP

临床医学论文-超早期小骨窗开颅治疗高血压脑出28例分析 【关键词】? 小骨 ??? 摘要：目的：探讨微创小骨窗开颅血肿清除术治疗高血压脑出血的效果。方法：将32例入院的高血压脑出血病例在头颅CT片指导下，行颞部直切口，小骨窗约3cm×3cm，直视下清除血肿，活动性出血以电凝止血。结果：28例中，18例完全恢复，生活半自理5例，偏瘫3例，无植物生存，死亡2例，死亡率10.7%。结论：应用超早期小骨窗开颅治疗高血压脑出血，既有简便，直接，微创和有效等优点，是比较理想的治疗高血压脑出血的措施。 ??? 关键词：高血压脑出血；微创手术;死亡率 ??? Therapy of? Hypertensive Cerebral Hemorrhoge in Small Bone Window Craniotomy Operation in Super Early Stage ??? Abstract: Objective: To explore the effects of minilally invasive operation (small bone window penestration in super early stage) on hypertensive?cerebral hemorrhage. Method: Directed by the patient抯 skull CT. 32 cases are operated on using the minimal?invasive?operation with incisions measuring,The bone window?was only 3.0?.0cm .the hematoma was sucked out liquid direct vision and active?bleeding was theated?whih electric coagulation. Result: Among the 28 cases,2 cases died,and the death rate was 10.7%,18 cases completely recovered and 5 cases were semrself-cared .3 cases were in hemiplegia ,and no patient was in persistent vegetative state. Conclusion: The treatment of hypertensive cerebral hemorrhage by the? small bone window in super early stage? is simple , convenient ,direct ,miniwounded ,effective,This is an ideal curement for hypertensive cerebrel hemorrhage. ??? Key words：Hypertension cerebrd hemorrhoge；Minilally invasive operation；Death rate ??? 我院于2000年7月至2004年6月采用超早期小骨窗微创手术方法开颅血肿清除术治疗高血压脑出血28例,取得良好效果,现总结并报告如下。 ??? 1资料与方法 ??? 1.1一般资料：28例中男17例,女11例;年龄51～75岁,平均62.8岁。入院前均有高血压病史。临床表现:深昏迷10例,中度昏迷12例,浅昏迷6例;瞳孔不等大者5例,肢体均有不程度的偏瘫。ＧＣＳ评分:3～5分者15例,6～8分者13例。头颅ＣＴ检查:血肿位于基底节区26例,脑叶皮层下2例,其中基底节区脑出血破入脑室者4例,中线结构移位者21例。血肿量:50～60ｍｌ15例,60～70ｍl 9例,超过70ｍl 4例,平均62.8ｍｌ。所有病人均在发病后6h内手术。 ??? 1.2方法：手术都是在ＣＴ指导下进行。其中顶部皮层切口手术2例,颞部直切口手术26例。一般手术于患侧耳前,以颧弓上缘为底端,向上行直切口约6～8ｃｍ长,切口方向视血肿偏前或偏后而定,皮肤肌肉牵开后显露颞部骨板,在靠近最底端处钻孔并扩大成约3cm×3ｃｍ的骨窗。悬吊硬脑膜后放射状切开,在颞中回或颞下回上部边缘处以脑穿针穿刺血肿,确认血肿后沿此穿刺道进入直达血肿,以细吸引器头吸除血肿,动作要轻柔，尽量不要吸到脑组织 ，边冲洗边吸除直至全部清除。术中可借助脑压板随时调整吸除方向,以利清除各方向残存血肿。吸引器头端切忌超过血肿界线。对血肿壁和底部的点状小凝血块不可勉强刮除,以防止再出血。对血肿腔的渗血和活动性出血用电凝,或明