高血压脑出血脑疝手术效果及影响因素分析.docVIP

高血压脑出血脑疝手术效果及影响因素分析 　　[摘 要] 目的：分析高血?耗猿鲅?脑疝手术效果及影响因素，探讨高血压脑出血脑疝的预后预测指标。方法：回顾性分析2013年2月―2016年2月于我院接受手术治疗的高血压脑出血脑疝患者105例资料。按照患者术后6个月预后质量，将格拉斯哥预后评分（GOS）Ⅳ～Ⅴ级者纳入预后良好组，将Ⅰ～Ⅲ级者纳入预后不良组，分析年龄、GCS评分、血肿量、手术时机等因素对患者预后的影响。结果：105例患者中，预后良好46例（43.81%），预后不良59例（56.19%）。大量血肿、GCS评分≤8分、脑室积血、中线移位≥1 cm、术后再出血、术后肺部感染为影响高血压脑出血脑疝手术效果的独立危险因素，发病后6 h内手术为保护性因素（P0.05）。结论：急诊大骨瓣减压血肿清除术对合并脑疝患者效果尚可，充分减压，尽早实施手术、完善围术期综合治疗，有望降低患者病死、病残率。 　　[关键词] 高血压脑出血；脑疝；手术；影响因素 　　中图分类号：R742 文献标识码：A 文章编号：2095-5200（2017）01-053-03 　　DOI：10.11876/mimt201701021 　　Analysis of the factors and surgical effect of in treatment of hypertensive cerebral hemorrhage complicated with cerebral hernia LIU Haibo，YANG Zhongxin，FAN Yingjun，ZHANG Jie. （Department of Neurosurgery，The First Affiliated Hospital of Chengdu Medical College，Chengdu 610000 China） 　　[Abstract] Objective： This study aimed to analyze the effect and factors of hernia surgery in treatment of hypertensive cerebral hemorrhage， and to discuss the predictors for the prognosis of hypertensive cerebral hemorrhage complicated with cerebral hernia. Methods： A retrospective analysis was conducted to analyze the data of 105 cases of hypertensive cerebral hemorrhage combined with cerebral hernia admitted to our hospital for surgical treatment from February 2013 to February 2016. According to the prognosis quality of patients 6 months after operation， patients’ prognosis quality was evaluated by the Glasgow Outcome Scale （GOS） as IV-V were included in the good prognosis group， I-III in poor prognosis group， and the effect of age， GCS score， hematoma volume， operation time and other factors on the prognosis of the patients were analyzed. Results： Among the 105 patients， the prognosis was good in 46 cases （43.81%）， and the prognosis was poor in 59 cases （56.19%）. A large amount of hematoma， GCS score≤8， intraventricular hemorrhage， midline shift≥1 cm， postoperative bleeding， postoperative pulmonary infection was the independent risk factor of surgical effect of hypertensive cere