小骨窗显微外科治疗高血压脑出血临床探究.docVIP

小骨窗显微外科治疗高血压脑出血临床探究 　 作者：孙志刚 陈伟 包金锁 佟强 林海峰 杜成华 朱彬 【摘要】 目的 研究高血压脑出血手术的微创化和减少周围神经组织的继发性损伤。 方法 利用小骨窗开颅和显微外科技术治疗126例高血压脑出血，与对照组（常规手术组）比较术后患者的生存质量、并发症及预后。 结果 患者重残率、病死率明显下降，血肿清除率明显提高，血肿复发率下降。术后24h GCS评分明显提高。 结论 采用显微外科技术可以有效保护血肿周围脑组织和重要豆纹动脉穿通支，减少因手术引起的继发性损伤。术后神经功能恢复快，并发症少，可以发现肉眼难以发现的合并症。 关键词 高血压脑出血 显微外科 小骨窗开颅 Clinical study on microcraniotomy and micromanipulation in treatment of hypertensive cerebral hemorrhage 【Abstract】 Objective To decrease traumatic and the secondary injury of brain tissue during hypertensive cerebral hemorrhage operation.Methods Microcraniotomy and micromanipulation were applied to the treatment of126patients with hypertensive cerebral hermorrhage.The patient life quality and survival rate were compared to those with routine operation.Results The patient life quality and survival rate were improved.Severe disability and mortal-itywere decreased remarkably.Hemorrhage eliminable rates were increased and hemorrhage relapse rates were de-creased.The Glasow coma score（GCS）of those patients were increased during24hours after operation.Conclusion Micromanipulation during operation effecttively protects the surrounding brain tissue and perforating branch and de-creases the secondary artery injures and surrounding brain tissue infarction after the operation.The postoperative ner-vous functions were recoveried fastly and postoperative complications were decreased. Key words hypertensive cerebral hemorrhage micromanipulation microcraniotomy 高血压脑出血是一类严重危害人类健康的常见病，其病死率、致残率高。我科从1997年1月～2001年6月行高血压脑出血显微外科小切口骨窗开颅血肿清除术126例与开颅非显微组180例对照研究，现将结果报告如下。 1 临床资料 1.1 一般资料 显微组共126例，其中男74例，女52例;年龄37～76岁，平均51.8岁;高血压病史1～32年，平均12.8年。对照组共180例，其中男107例，女73例;年龄35～73岁，平均53.5岁;高血压病史2～30年，平均14.5年。1.2 术前意识情况 按金谷春的等级标准分类，见表1。 表1 两组患者术前意识状况分析表 例（略） 1.3 术前血肿情况 所有患者术前均行CT检查，以CT影像计算血肿量，见表2、表3。 表2 显微组术前血肿情况 （略） 表3 对照组术前血肿情况 （略）注:基底节出血按Scheinker分类:（1）外侧型:壳核与外囊;（2）内侧型:丘脑与丘脑下部和内囊出血;（3）混合型:内侧外侧都有血肿 1.4 手术时机 显微组:发病7h内手术43例，7～24h手术53例，24～72h手术18例，72h后手术12例。对照组:发病7h内手术58例，7～24h手术67例，24～72h