高血压脑出血术后脑梗死临床救治剖析.docVIP

高血压脑出血术后脑梗死临床救治剖析 　　[摘要] 目的:探讨高血压脑出血术后脑梗死的致病因素和临床救治措施。方法:收集并分析本院2003～2009年收治的9例高血压脑出血术后脑梗死患者的临床资料。结果:本组所有患者治疗后按ADL评分:ADLⅡ级2例,Ⅲ级3例,Ⅳ级2例,V级1例,死亡1例。结论:脑梗死是高血压脑出血术后的一种严重并发症,致病因素复杂。早期诊断、综合防治能降低高血压脑出血术后脑梗死患者的死亡率、伤残率,提高生存质量。 　　[关键词] 高血压脑出血;手术;并发症;脑梗死 　　[中图分类号] R743.34 [文献标识码]A [文章编号]1674-4721(2010)05(c)-017-02 　　 　　Diagnose and treatment of cerebral infarction following surgery for hypertensive cerebral hemorrhage 　　ZHANG Xiaoqiang 　　(Department of Neurology,The Peoples Hospital of Guangan City,Sichuan Province, Guangan 638000,China) 　　[Abstract] Objective:To explore the pathologenetic causes and clinical countermeasures of cerebral infarction following the surgery for hypertensive cerebral hemorrhage(HCH).Methods:The clinical data of 9 patients with cerebral infarction following the surgery for HCH,who were treated in our department from 2003 to 2009,which were analyzed retrospectively.Results: 9 patients with cerebral infarction,2 cases belonged in gradeⅡof activities of daily living(ADL),3 cases in grade Ⅲ,2 cases in grade Ⅳ,1 cases in gradeⅤ,and 1 cases was died.Conclusion:Hypertensive cerebral is a serious complication after surgery for hypertensive cerebral hemorrhage,the pathogenic factors are very complex,is one of the most severe complication safter the surgery for HCH.The forepart ofdiagnoses and comprehensive treatment may decrease mortality and disabled rate,and enhance survival quality in the patients with cerebral infarction after surgery for HCH. 　　[Key words] Cerebral hemorhage of hypertension;Surgery;Complication; Cerebral infarction 　　 　　本科于2003～2009年收治高血压脑出血术后脑梗死患者9例,现将其救治情况报道如下: 　　1 资料与方法 　　1.1一般资料 　　本组患者男5例,女4例;年龄43～77岁,平均57.2岁。均有2年以上高血压史(最长达26年)。其中合并有心脏病者5例,糖尿病者4例,高血脂者6例,术前CT未发现脑梗死病灶。均以突发意识障碍和(或)肢体偏瘫为主要表现,伴有头痛和呕吐;其中嗜睡1例,浅昏迷5例,中度至深度昏迷3例;脑疝4例。 　　1.2 手术方法 　　本组患者2例行开颅血肿清除并去骨瓣减压,7例行小骨窗开颅血肿清除术,血肿清除同时行侧脑室外引流3例。6 h以内手术者3例,6～24 h手术者6例。 　　1.3脑梗死临床表现及梗死部位 　　术后12 h～7 d行头颅CT检查发现脑梗死病灶。其中,枕顶叶4例,颞枕叶3例,基底节2例;手术同侧6例,对侧2例,双侧1例。梗死灶直径3.0～6.5 cm,平均4.3 cm