无显著占位效应高血压脑出血微创治疗.docVIP

无显著占位效应高血压脑出血微创治疗【摘要】 目的 针对高血压脑出血小型血肿，为尽量减轻血肿对脑组织产生的不良影响，提高患者生存质量，探讨安全、微创、简便、有效的手术方法。方法 以头颅CT片为血肿定位，采用床边锥颅置管抽吸引流的方法对25例血肿量在20～30 ml的高血压脑出血患者，在血肿形成早期进行手术治疗。结果 21例患者在术后第1天肢体肌力进步1级以上，出血后1个月作生活能力(ADL)评级，Ⅰ、Ⅱ级共23例，Ⅲ级1例，Ⅳ级1例。结论 以头颅CT片定位，采用床边锥颅置管引流治疗高血压脑出血小血肿，具有微创，简便及效果显著的优点。 【关键词】高血压脑出血；占位效应；外科治疗 Treatment of hypertensive cerebral hemorrhage without remarkable occupied effect by minimally invasive method WANG Bin.Department of Neurosurgery,Peoples Hospital,Huaibei,Anhui Province 235000,China 【Abstract】 Objective To explore an operational method of safety,microtrauma,convenience and effectiveness for hypertensive intracerebral hemorrhage (HICH)with small hematoma,alleviate bad effects exerted by hematoma towards brain system and improve the patients?life quality.Methods 25 patients suffering from HICH with hematoma volume ranging from 20 to 30 ml were treated by the approach of bedside keyhole pipe-implanting,aspiration and drainage under the guidance of CT for hematoma at its early stage of formation.Results 21 patients improved dynamic of contralateral limb for more than 1 grade a day after operation and recovered after 1 month according to the scale for activity of daily living (ADL)after hemorrhage with their scales varying from I,Ⅱ(23 cases in all),Ⅲ(1 case)to IV(1 case).Conclusion The approach of bedside keyhole, pipe-implanting,aspiration and drainage under the guidance of CT enjoys distinct advantages of microtrauma,convenience and effectiveness for the treatment of HICH with small hematoma. 【Key words】Hypertensive intracerebral hemorrhage；Occupied effect； Surgical treatment 高血压脑出血是常见的多发病，发病率约为15/10万~35/10万，死亡率高，幸存者中大部分不同程度存在各种神经功能障碍。脑出血引起明显的占位效应是传统的手术指征之一。但对于早期血肿体积较小，无明显占位效应的脑内血肿采取手术治疗还是保守治疗说法不一。我科自2003年9月至2006年9月采用床边锥颅血肿穿刺抽吸引流治疗无明显占位效应的高血压脑出血患者，收到良好的效果，现报告如下。 1 资料与方法 1．1 一般资料 患者选自2003年9月至2006年9月我科收治的高血压脑出血患者25例。所有患者既往均有高血压病史。依据临床及CT，手术等排除外伤性，动静脉畸形，肿瘤卒中等疾病。其中男18例，女7例；年龄47~75岁，平均59．3岁；按GCS评分，12~15分，所有患者均有不同程肢体偏瘫，肌力0~Ⅳ级。失语15例。依据多田氏公式计算出血量在2