150例高血压脑出血患者手术治疗研究.doc

150例高血压脑出血患者手术治疗研究[摘要] 目的：分析高血压脑出血手术治疗的疗效。方法：利用150例高血压脑出血手术治疗患者资料，其中开颅血肿清除术加去骨瓣减压术25例，直切口小骨窗开颅血肿清除术26例，微创血肿引流术99例。观察比较3组患者GCS评分，出血量和手术时机的关联。结果：患者GCS评分越高和血肿量较小者预后较好，患者24 h后手术预后比在6 h内及6～24 h内手术差。结论：不同的血肿量决定了患者的不同预后，不同的手术方法对预后无显著性差异，超早期或早期手术能降低病死率，提高手术疗效。 [关键词] 高血压；脑出血；手术；治疗 [中图分类号] R722.15+1 [文献标识码]A[文章编号]1674-4721（2011）08（b）-036-02 The 150 patients study on surgery treatment for hypertensive intracerebral hemorrhage HUANG ZhenLin, ZHEN Yun, LI Yuhu, HU Shaojie, CHEN Qisheng, LI Weilian Department of Neurosurgery, Xixiang People′s Hospital of Baoan District in Shenzhen City, Guangdong Province, Shenzhen 518102, China [Abstract] Objective: To analyze the effect of surgical treatment for patients with hypertensive intracerebral hemorrhage. Methods: 150 HICH patients treated by surgery were analyzed. Among these cases, 25 patients were treated with hematoma evacuation plus decompresive craniectomy, another 26 cases with craniotomy and hematoma evacuation and the other 99 with burr hole evacuation and drainage. Data of these patients such as GCS score, hematoma volume and operative opportunity were analyzed. Results: Higher GCS score, smaller hematoma volume, and earlier surgical intervention were good predictors of outcome. Conclusion: For HICH patients with high GCS score and small hematoma volume early surgery can achieve good outcome, no matter what kind of surgical method is performed. [Key words] Hypertension; Intracerebral hemorrhage; Surgery; Treatment 高血压脑出血（hypertensive intracerebral hemor-rhage，HICH）是一种高发病率、高致残率和高致死率的全球性疾病，是危害人类健康既常见又严重的疾病，位居老年人三大死亡原因之首[1]。本文分析了150例HICH手术患者，观察总结不同手术方式的疗效，并进行相关因素分析，报道如下： 1 资料与方法 1.1 一般资料 高血压脑出血患者150例，男88例，女62例。年龄30～81岁，平均（59.2±9.5）岁。血肿量：30～50 ml 82例，51～100 ml 44例，100～175 ml 24例，所有患者均有3年以上的高血压病史，入院时血压在180～220/110～130mmHg。入院时GCS评分3～5分21例，6～8分45例，9～12分69例，13～15分15例，手术在发病后6 h内有78例，手术在6～24 h者45例，手术在24 h以后有27例。 1.2 分组和手术方法 应用显微外科技术进行血肿清除（微创组）99例。根据血肿的大小和部位，采用骨瓣开颅，术后去骨瓣减压 （去骨瓣组）25例。根据血肿部位行6 cm直切口，