小骨窗与常规骨瓣开颅治疗高血压脑出血效果分析.doc

小骨窗与常规骨瓣开颅治疗高血压脑出血效果分析 【摘要】? 目的 比较小骨窗与常规颞顶瓣开颅术治疗高血压脑出血的效果。方法 符合标准的高血压脑出血病人113例，分为2组，其中小骨窗组57例，常规骨瓣组56例。所有病人均经CT扫描为幕上出血。小骨窗治疗组根据血肿部位采用小骨窗开颅术(3 cm×3 cm)。常规骨瓣组根据血肿部位采用颞顶瓣或额颞瓣开颅减压方法( 6 cm×8 cm)。结果 小骨窗开颅治疗组病人恢复良好率明显高于常规骨瓣组，长期昏迷和中残率低于常规骨瓣组(P0.05)，小骨窗治疗组患者术后脑水肿和切口脑脊液漏发生率均低于常规骨瓣组(P0.05)。结论 小骨窗开颅术治疗高血压脑出血病人的疗效明显好于常规颞顶瓣开颅术。 【关键词】? 小骨窗;常规骨瓣;高血压脑出血 　　【Abstract】 Objective To compare the effect of small window craniotomy and routine craniotomy treating 113 patients with hypertensive intracerebral hemorrhage(HICH).Methods All patients were confirmed the hypertensive supratentorial intracerebral hemorrhage by CT scan, and were divided into two groups: small window craniotomy group (n=57) and routine craniotomy group(n=56). Small window craniotomy group adopted small craniotomy according to hematoma sites. Routine craniotomy group adopted temporalparietal lobe or front temporal craniotomy flap(6 cm×8 cm) according to hematoma sites. Results There were statistically significant differences between small window craniotomy group and routine craniotomy group(P0.05) by chisquare test analysis. Recovery in small window craniotomy group was better than routine craniotomy group, and longterm coma, the rate in the disability, brain edema and cerebrospinal fluid leakage of incision in small window craniotomy group was lower than routine craniotomy group(P0.05).Conclusion The treatment effect of patients with HICH in small window craniotomy group is better than that in routine craniotomy group. 　　【Key words】 Small window craniotomy; Routine craniotomy; Hypertensive intracerebral hemorrhage 　　高血压脑出血(hypertensive intracerebral hemorrhage，HICH)是一种常见病，病死率为脑血管病患者的首位,占卒中病人的10% ～30%[1]，通常病情危重，存活者多有严重病残[2]。将我院2005—2008年符合入选标准的高血压脑出血病人113例采用小骨窗与常规骨瓣开颅术治疗，分析和评价治疗效果，现介绍如下。 　　1 资料与方法 　　1.1 选择标准 (1)有高血压史或发病时血压升高并排除其他原因的自发性脑出血。(2)CT扫描显示为幕上出血，出血量30～110 ml。(3)入院时生命体征相对平稳，GCS评分6，脑疝1 h以内，鞍上池无明显闭塞。 　　1.2 一般资料 113例患者均符合高血压脑出血诊断标准。小骨窗组57例，男35例，女22例， 年龄45～80岁，平均64.5岁;高血压史29例，糖尿病史5例，冠心病史2例。常规骨瓣组56例，男36例，女20例，年龄4