首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 125 毫秒
1.
Objective: In order to study the clinical manifestation and risk factor of recurrent intracerebral hemorrhage(ICH).Methods:The 256 patients were analysed who admitted to our hospital for intracerebral hemorrhage between 1995 and 1997.The 15(5 .86%)patients had a recurrent ICH.There were 9 men and 6 women and the mean age of the patients was 63.5 ± 6.4years at the first bleeding episode and 67.8± 8. 5 years at the second. The mean interval between the two bleeding episodes was 44.6 ± 12.5 months. The 73.3%patients were hypertensive .′The site of the first hemorrhage was ganglionic in 8 patients , ]ohar in six paients and brainstem in one .The recurrent hemorrhage occurred at a different location from the previous ICH.The most common pattern of recurrence was “ganglionic -ganglionic” (7 patients), lobar - ganglionic (3 patients), lobar-lobar(three patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor. By comparison with 24 patients followed up to average 47.5± 18.7 months with isolated ICH without recurrence .Only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanism of recurrence of ICH were multiple(hypertension, cerebral amyloid angiopathy).Contral of blood pressure and good living habit after the first hemorrhage may prevent ICH recurrences.  相似文献   

2.
BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING: The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS: A total of 225 intracerebral hemorrhage patients (142 males and 83 females) that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS: According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement (n = 20) and non-hematoma enlargement (n = 205) groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES: The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS: In the hematoma enlargement group, 15 patients (79%) developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients (43%) presented with electrocardiographic abnormalities. There were sig  相似文献   

3.
BACKGROUND: Secondary lesions can occur in tissues surrounding the hematoma following intracerebral hemorrhage, with the presence of inflammatory reactions, cytokine expression and apoptosis These have been confirmed in animal studies. Our study sought to determine whether these could be detected in human tissues surrounding the hematoma following intracerebral hemorrhage. OBJECTIVE: To investigate expression of inflammatory cytokines, Bax and Bcl-x, and identify neural cell apoptosis in tissues surrounding the hematoma, and to analyze the correlation between them and pathological damage in intracerebral hemorrhage patients. DESIGN, TIME AND SETTING: This histopathology, controlled study was performed at the Department of Neurosurgery, Sichuan People's Hospital, China, from January 2003 to January 2005. PARTICIPANTS: Brain tissues 1 cm from the hematoma in 30 intracerebral hemorrhage patients served as the experimental group. Brain tissues located away from the hematoma in 7 patients served as the control group. METHODS: TUNEL was used to detect neural cell apoptosis. Immunohistochemistry (labeled dextran polymer) and RT-PCR were used to measure tumor necrosis factor- α, interleukin-1 β, interleukin-6, Bax and Bcl-x protein and mRNA expression. Pathological changes in brain tissues surrounding the hematoma were observed following HE staining. MAIN OUTCOME MEASURES: Neural cell apoptosis, inflammatory cytokines, Bax and Bcl-x protein and mRNA expression, pathological changes in brain tissues surrounding the hematoma. RESULTS: Brain tissues surrounding the hematoma were mildly damaged within 6 hours, severely damaged at 24-72 hours, and significantly improved 1 week following intracerebral hemorrhage. Expression of tumor necrosis factor- α protein and mRNA, interleukin-1β and interleukin-6 mRNA was not significant in tissues surrounding the hematoma, which was identical to the control group within 6 hours after intracerebral hemorrhage. This expression was significantly higher compared with  相似文献   

4.
《中国神经再生研究》2016,(7):1122-1127
Clinical outcomes are positively associated with hematoma absorption.The monocyte-macrophage scavenger receptor,CD163,plays an important role in the metabolism of hemoglobin,and a soluble form of CD163 is present in plasma and other tissue fluids;therefore,we speculated that serum CD163 affects hematoma absorption after intracerebral hemorrhage.Patients with intracerebral hemorrhage were divided into high-and low-level groups according to the average CD163 level(1,977.79 ± 832.91 ng/m L).Compared with the high-level group,the low-level group had a significantly slower hematoma absorption rate,and significantly increased National Institutes of Health Stroke Scale scores and modified Rankin Scale scores.These results suggest that CD163 promotes hematoma absorption and the recovery of neurological function in patients with intracerebral hemorrhage.  相似文献   

5.
BACKGROUND: Secondary lesions can occur in tissues surrounding the hematoma following intracerebral hemorrhage, with the presence of inflammatory reactions, cytokine expression and apoptosis. These have been confirmed in animal studies. Our study sought to determine whether these could be detected in human tissues surrounding the hematoma following intracerebral hemorrhage. OBJECTIVE: To investigate expression of inflammatory cytokines, Bax and Bcl-x, and identify neural cell apoptosis in tissues surrounding the hematoma, and to analyze the correlation between them and pathological damage in intracerebral hemorrhage patients. DESIGN, TIME AND SETTING: This histopathology, controlled study was performed at the Department of Neurosurgery, Sichuan People's Hospital, China, from January 2003 to January 2005. PARTICIPANTS: Brain tissues I cm from the hematoma in 30 intracerebral hemorrhage patients sewed as the experimental group. Brain tissues located away from the hematoma in 7 patients served as the control group. METHODS: TUNEL was used to detect neural cell apoptosis, lmmunohistochemistry (labeled dextran polymer) and RT-PCR were used to measure tumor necrosis factor-α , interleukin-1β, interleukin-6, Bax and Bcl-x protein and mRNA expression. Pathological changes in brain tissues surrounding the hematoma were observed following HE staining. MAIN OUTCOME MEASURES: Neural cell apoptosis, inflammatory cytokines, Bax and Bcl-x protein and mRNA expression, pathological changes in brain tissues surrounding the hematoma. RESULTS: Brain tissues surrounding the hematoma were mildly damaged within 6 hours, severely damaged at 24-72 hours, and significantly improved 1 week following intracerebral hemorrhage. Expression of tumor necrosis factor-α protein and mRNA, interleukin-1 β and interleukin-6 mRNA was not significant in tissues surrounding the hematoma, which was identical to the control group within 6 hours after intracerebral hemorrhage. This expression was significantly higher compared with the control group from 12-72 hours, and gradually decreased after 72 hours. The number of apoptotic neural ceils reached a peak between 12-72 hours. Tumor necrosis factor-α protein and mRNA, interleukin-1β and interleuldn-6 mRNA levels were positively correlated with apoptosis, Bax protein and mRNA levels (P < 0.01). CONCLUSION: Tumor necrosis factor-α, interleukin-1β, and interleukin-6 levels are highly correlated with apoptosis. With the decrease in tumor necrosis factor-α, interleukin-1β and interleukin-6 levels, the number of apoptotic cells gradually reduced.  相似文献   

6.
Hematoma enlargement-related factors in hypertensive cerebral hemorrhage☆   总被引:1,自引:0,他引:1  
BACKGROUND:Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE: To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING: A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS: Fifty-eight males and thirty-one females aged (52.7 ± 5.23) years (range, 28-73 years). METHODS: Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group (n = 30), and those with no obvious hematoma changes served as the control group (n = 60). Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES: Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS: There were no significant differences in hemorrhage sites between the two groups (χ2 = 2.262, P 〉 0.05). The percent of intemperance patients in the observation group was significantly larger than the control group (χ2 = 6.923, P 〈 0.01). No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups (χ2 = 0.03, 0.08, P 〉 0.05). The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group (χ2 = 25.57, P 〈 0.01). CONCLUSION: Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patien  相似文献   

7.
BACKGROUND: Presently, there have been craniocerebral operation, interventional embolization, stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation (AVM). However, the standard of different therapeutic regimens of cerebral AVM at the acute stage of hemorrhage has not been completely identified. OBJECTIVE: To observe the clinical characteristics and therapeutic effects of AVM at the acute stage of hemorrhage in patients, and to analyze corresponding therapeutic strategies. DESIGN: Non-randomized clinical observation. SETTING: Department of Neurosurgery, Foshan First People's Hospital, Sun Yat-sen University. PARTICIPANTS: Forty-six patients with cerebral AVM complicated by hemorrhage admitted to Department of Neurosurgery, Foshan First People's Hospital between January 1999 and December 2006, were involved in this study. All the patients were confirmed as cerebral AVM complicated by hemorrhage by brain angiography or/and postoperational pathology. The involved patients, 32 males and 14 females, averaged 25 years old, ranging from 6 to 62 years. Informed consents of therapeutic items were obtained from the relatives of all the patients. METHODS: ①On admission, skull CT and brain angiography were conducted in the involved subjects. ②The therapeutic method was confirmed according to the consciousness, hematoma region, hematoma volume, imageological results following comprehensive analysis. DSA examination was permitted to identify the size and position of abnormal vessel mass, and the distribution of feeding artery and draining vein. Craniocerebral operation was carried out as early as possible in patients with severe or progressive conscious disturbance, in which most of hematoma with obvious occupied effect or cerebral hernia was located in lobe of brain. The primary thing was to clean intracerebral hematoma for in time decompression. According to different situations, corresponding therapeutic measures were used for resecting abnormal vessel mass, and the treatments of patients were observed. ③The therapeutic effects were assessed following Glasgow outcome scale(GOS) at 3 months after hemorrhage. MAIN OUTCOME MEASURES: ① The examination results of skull CT and brain angiography of patients on admission. ② Treatment of patients. ③ GOS results at 3 months after hemorrhage. RESULTS: Forty-six patients were involved, and all of them participated in the final analysis. ① Examination results of skull CT and brain angiography: Bleeding part: frontal lobe in 7 cases, parietal lobe 15, temporal lobe 19, occipital lobe 3, cerebellar hemisphere 2, and hemorrhage rupturing into ventricle 10. Haematoma volume: small volume of hematoma (< 20 mL)in 4 cases, moderate volume of hematoma (20–50 mL)14 , large volume of hematoma (50–80 mL)21, great volume of hematoma (> 80 mL) 7; Abnormal vessel mass: Among 17 patients undergoing aortocranial angiography, abnormal vessel mass was found in 16 patients, including cortex 13 patients, basal ganglia and thalamencephalon(deep part) 2 patients , and posterior cranial fossa 1 patient. The size of abnormal vessel mass: small (< 3 cm) 4 patients, moderate (3–6 cm) 9 patients, and large (> 6 cm) 3 patients. The type of feeding artery: perforating branch blood-supply 1 patient, cortical branch blood supply 13 patients, mixed branch blood supply 2 patients. The type of draining vein: cortical draining (superficial part) 10 patients, deep part draining 2 patients, and mixed draining 4 patients. ② Treatment condition: Among 17 patients undergoing brain angiography followed by craniocerebral operation, hematoma was removed and AVM was completely resected in 12 patients, hematoma was removed and AVM was partially resected in 3 patients, and only hematoma was resected in 2 patients; Among 24 patients undergoing emergent craniocerebral operation, hematoma was removed and AVM was completely resected in 5 patients, hematoma was removed and AVM was partially resected in 9 patients, and only hematoma was resected in 10 patients; Expectant treatment was carried out in the early stage in 5 patients. When disease condition was stable, AVM resection was separately or complicatedly conducted in 13 patients, embolization in 4 patients, and γ- radiotherapy in 5 patients. ③GOS: 5 patients died in postoperative complications, and among the other patients, 19 had moderate or had not functional impairment, 13 had moderate disability, 6 had severe disability, 2 were vegetative state, and 2 died. ④ Post-operative re-examination of brain angiography: Among 16 patients undergoing AVM, vessel mass disappeared in 9 patients. CONCLUSION: Good therapeutic effects can be obtained by choosing proper therapeutic regimen according to clinical and imageological characteristics of patients with arteriovenous malformation complicated by hemorrhage at the acute stage.  相似文献   

8.
目的 提高外伤性纵裂血肿的临床疗效.方法 回顾性分析21例经显微手术治疗的外伤性纵裂区血肿的临床资料、手术方法和手术疗效.结果 按GOS治疗结果评定,术后随访1-9年,恢复良好16例,中残2例,重残1例,植物生存1例,死亡1例.21例均有明确出血来源,大脑前动脉远段分支破裂出血和纵裂区静脉破裂出血者以全纵裂血肿多见且手术效果较好,纵裂区脑组织挫伤出血者以局部纵裂血肿和挫伤水肿为主,部分患者预后较差.结论 正确掌握外伤性纵裂区血肿的手术指征和手术技巧,及时手术治疗,有助于改善外伤性纵裂血肿患者的预后.
Abstract:
Objective To study the treatment and clinical outcomes of traumatic interhemispheric subdural hematoma ( TISH ). Method The clinical datum, surgical management and outcomes of 21 patients with TISH treated with mircrosurgery were analyzed retrospectively. Results According to Glasgow coma scale(GCS) ,good recovery was found in 16 cases, moderate disability in 2, severe disability in 1, vegetative survival in 1, and death in 1 during postoperative follow - up period (1-9 years ). There were confirmed sources of hemorrhage in all 21 cases. The whole cerebral longitudinal fissure hematoma was more frequently seen in patients with hemorrhage from rupture of the distal part of anterior cerebral artery and veins in the cerebral longitudinal fissure, the prognosis was usually good. Local hematoma, laceration and edema in the cerebral longitudinal fissure were more frequently seen in patients with hemorrhage from brain tissue laceration of the longitudinal fissure, the prognosis was usually poor. Conclusions Good understanding of surgical indications, commanding of surgical skills and timely surgical intervention are helpful in improving the prognosis of TISH patients.  相似文献   

9.
BACKGROUND: Previous researches demonstrated that neurovascular decompression could cure hypertension; however, whether it could effectively control refractory hypertension after hypertensive cerebral hemorrhage should be further studied. OBJECTIVE: To observe the effect of neruovascular compression on intracranial vagus for blood pressure of dogs and investigate the effect of neurovascular decompression on blood pressure of patients with hypertensive cerebral hemorrhage. DESIGN: Randomized controlled animal study, clinical effects and retrospective analysis. SETTING: Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA. MATERIALS: The experiment was carried out in the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from May to October 2006. A total of 15 healthy adult dogs of both genders were randomly divided into experimental group (n =10) and control group (n =5). Clinical observation: A total of 41 patients with hypertensive cerebral hemorrhage were selected from the Department of Neurosurgery, General Hospital of Nanjing Military Area Command of Chinese PLA and the Department of Neurosurgery, Changzheng Hospital Affiliated to the Second Military Medical University of Chinese PLA from October 1999 to October 2006. Among them, one patient had brain stem hemorrhage. There were 27 males and 14 females aged from 41 to 66 years. Inclusion criteria: All patients were diagnosed with CT examination once or several times. Volume of hematoma ranged from 50 to 120 mL and had obviously operative indication. All patients provided consents. In addition, another 281 patients with hypertensive cerebral hemorrhage who received traditionally internal and surgical therapies in our departments of neurosurgery, neurology and emergency room were selected in the control group. METHODS: ① Animal experiments: 20 cm autochthonous great saphenous vein was taken from dogs in the experimental group and coincided with tip of facial artery to form arterial loop so as to oppress left vagus and lateral bulb abdomen. In addition, 20 cm autochthonous great saphenous vein was taken from dogs in the control group and coincided with tip of facial artery to establish arterial loop so as to oppress left cerebellum to observe changes of blood pressure before and at 1, 2, 3 and 4 weeks after operation. ② Clinical observation: Among 41 patients with hypertensive cerebral hemorrhage including one with brain stem hemorrhage, they received microvascular decompression of vagus immediately after getting rid of intracerebral hematoma and stopping bleeding to observe its effect of depressurization. All patients and their relatives provided consents. ③ A total of 281 patients with hypertensive cerebral hemorrhage who discharged after the treatment of traditionally internal and surgical therapies were studied retrospectively to observe changes of blood pressure after routine treatment and compare the results with neurovascular decompression. MAIN OUTCOME MEASURES: ① Changes of blood pressure of experimental dogs; ② effect of vascular decompression of vagus for blood pressure of patients with hypertensive cerebral hemorrhage after clearing intracerebral hematoma; ③ different effects of neurovascular decompression and routinely internal and surgical therapies on hypertension. RESULTS: ① Results of animal experiments: Nine dogs in the experimental group survived. At 1, 2, 3 and 4 weeks after operation, blood pressure of dogs in the experimental group was (139.77±4.06), (149.11±4.90), (148.10±4.16), (147.76±4.15) mm Hg (1 mm Hg=0.133 kPa), which was higher than that of dogs in the control group [(117.20±2.74), (116.65±3.74), (116.26±1.8), (115.81±3.76) mm Hg, P < 0.01]. ② Results of clinical observation: Among 41 patients, 8 (20%) cases died during the operation. In addition, among other 33 (80%) survival patients, 11 (33%) cases had normal blood pressure; blood pressure of 14 (43%) cases was improved or closed to normal value; blood pressure of 8 (24%) cases was not changed obviously as compared with that before operation. ③ The results demonstrated that, by using traditionally internal and surgical therapies, among 281 patients with hypertensive cerebral hemorrhage, blood pressure of about 15% cases was recovered or closed to normal value. Those mentioned above did not have history of hypertension before hemorrhage. However, patients who had history of hypertension before hemorrhage received the traditionally internal or surgical therapies, and the blood pressure was not improved to the normal value after the treatment. CONCLUSION: ① Neurovascular compression in left intracranial vagus can cause obvious increase of blood pressure of dogs, and the increasing volume was 30 mm Hg. ② Vascular decompression of vagus has a great effect on refractory hypertension, and the improvement of blood pressure is superior to traditionally internal and surgical therapies in clinic.  相似文献   

10.
Objective To investigate the treatment of severe patients with thalamic hemorrhage into ventricles. Method 12 cases with thalamic hemorrhage into ventricular system were studied, 9 male, 3 femaie, with a mean age of 64 years. All patients were unconscious. The average size of hematoma was 65 ml. Besides general comprehensive care, they received ventricular puncture for ingertion of drainage tape into the cerebral ventricle, infusion with urokinase for clotlysis, lumbar puncture for letting out some cerebrospinal fluid and injection of dexemethasone. Result The patients' clinical symptoms and signs were obviously improved.. The CT scan also demonstrated that hematomas were removed faster. The effective rate was 83.3 per cent, with a murtality of 16.7 per cent. Cohclusion This kind of therapy can increase the clinical cure rate. decrease the disability rate and death rete.  相似文献   

11.
目的探讨超早期微骨孔人路神经内镜下手术辅以灌注尿激酶引流血肿治疗脑出血的疗效。方法26例患者在内窥镜下穿刺血肿手术,以CT评估血肿残留量,随访6个月,以GOS评估预后。结果术后复查CT血肿清除率:第1天:〈30%3例,30%~50%12例,50%~70%9例,〉70%2例;第3天:〈30%0例,30%~50%2例,50%~70%5例,〉70%19例。随访6个月GOS评估,良好18例,一般6例,较差2例,死亡1例。结论超早期微骨孔人路神经内窥镜下血肿清除辅以灌注尿激酶引流治疗高血压脑出血,具有精确性、直视性、微创性、简便性,血肿清除率高,致残率低及预后良好等优点。  相似文献   

12.
目的探讨显微血管减压(MVD)术后颅内出血的原因及应对策略。方法对12例面肌痉挛、三叉神经痛MVD术后颅内出血患者的临床资料进行回顾性分析,并对相关文献进行复习。结果本组患者中,小脑半球实质内血肿者3例,小脑出血破入脑室3例,蛛网膜下腔出血2例,脑室出血2例,后颅窝硬膜外血肿1例,幕上硬膜下血肿1例。1例脑室出血铸型患者家属放弃治疗,出血后48 h内死亡;4例患者行开颅血肿清除+后颅窝减压术;1例小脑半球实质内血肿患者采用立体定向穿刺引流术;2例患者单纯行侧脑室穿刺引流术;1例慢性幕上硬膜下血肿患者行钻孔引流术;3例患者采用保守药物及腰穿治疗。预后:康复5例,重度残疾1例,复合颅神经损害3例,死亡3例(住院期间死亡2例,出院半年内死亡1例)。结论MVD术后颅内出血具有较高的病死率、致残率,为MVD术后最严重的并发症之一。围手术期血压控制不良、责任血管发出穿支血管包绕神经出脑干区(REZ)及小脑半球牵拉干扰程度重是导致MVD术后颅内出血发生的原因。术后进行床旁移动CT检查能及时发现早期颅内出血,可有效降低其病死率和致残率。  相似文献   

13.
目的探讨立体定向引导微创血肿穿刺引流联合尿激酶治疗中等量高血压脑出血的临床效果。方法回顾性分析87例高血压脑出血病例,均为幕上出血,血肿量25~60mL,47例采用立体定向引导微创血肿穿刺引流联合尿激酶治疗,40例采用开颅血肿清除术治疗,分别于术后3d、7d观察血肿残余量、术后再出血情况、术后并发症情况;比较2组术后7d、14d、28d的临床疗效。结果立体定向引导微创血肿穿刺联合尿激酶组术后3d残余血肿量为(8.7±4.5)mL,7d为(2.5±1.3)mL,术后28d有效率为74.6%,术后并发症发生率为30.3%,与手术组比较差异均有统计学意义(P0.05或P0.01);术后再出血发生率为4.3%,与手术组比较差异无统计学意义(P0.05)。结论立体定向引导微创血肿穿刺联合尿激酶是治疗中等量高血压脑出血安全有效的方法,值得临床推广应用。  相似文献   

14.
尿激酶全脑室系统冲洗治疗脑室出血   总被引:5,自引:0,他引:5  
目的探讨大剂量尿激酶脑室内灌注,溶解脑室血肿的治疗效果方法2000年4月~2003年5月,我们对38例原发性高血压脑室出血的病人进行脑室、腰大池置管,建立外引流通道,大剂量尿激酶脑室内灌注治疗。结果术后l~4d脑室内血肿完全引出0,缩短了血肿吸收期。术后3~24h神志清醒达61%。出院时GOS评分:优良9例,轻残l5例,重残7例,植物生存3例,死亡4例。结论脑室、腰大池置管全脑室系统冲洗引流、大剂量尿激酶脑室内灌注治疗脑室血肿,效果满意。  相似文献   

15.
高血压脑出血外科治疗探讨   总被引:2,自引:0,他引:2  
目的探讨高血压脑出血外科手术方式的选择及其疗效。方法2002年6月~2007年6月采用微创穿刺引流术、小骨窗开颅、骨瓣开颅三种术式治疗高血压脑出血患者352例。结果存活314例(89.2%),按ADL分级:Ⅰ级169例,Ⅱ级62例,Ⅲ级30例,Ⅳ级28例,Ⅴ级25例。死亡38例(10.8%)。结论对出血部位及出血量不同的患者采用不同的手术方式及选择恰当的手术时机能明显的降低病死率及致残率,提高治愈率。  相似文献   

16.
根据丘脑出血患者入院时临床表现、出血量、脑室积血程度、中线移位程度、患者或家属意愿,分别选择保守治疗、双侧侧脑室额角钻孔引流术、CT定位血肿穿刺引流术+双侧侧脑室额角钻孔引流术和大骨瓣血肿清除术+去骨瓣减压术。120例患者共死亡33例,其中保守治疗7例、双侧侧脑室额角钻孔引流6例、双侧侧脑室额角钻孔引流术+CT定位血肿穿刺引流术8例、大骨瓣血肿清除术+去骨瓣减压术12例,不同治疗方式之间比较,差异具有统计学意义(P<0.05)。根据丘脑出血患者病情严重程度、出血量、脑组织受损范围等选择相应治疗方法,有益于提高治愈率及患者生存质量。  相似文献   

17.
目的探讨新型颅脑穿刺定位器结合新型头颅CT定位贴片辅助软通道穿刺引流术治疗高血压脑出血的应用效果及其临床意义。 方法选取湖州市中心医院神经外科自2014年1月至2015年12月行颅内血肿软通道穿刺引流术的45例高血压脑出血患者作为对照组,应用普通心电电极片CT定位法辅助穿刺;选取2016年1月至2018年7月行颅内血肿软通道穿刺引流术的48例高血压脑出血患者作为观察组,应用新型颅脑穿刺定位器结合新型头颅CT定位贴片辅助穿刺。对比2组患者的手术治疗效果和临床预后,并对新型颅脑穿刺定位器结合新型头颅CT定位贴片辅助定位法的经济性和实用性进行分析。 结果与对照组比较,观察组术中出血量更少,血肿清除率更高,且差异均具有统计学意(P<0.05);2组患者的手术时间比较,差异无统计学意义(P>0.05);观察组住院时间少于对照组,且术后3个月的预后优于对照组,差异具有统计学意义(P<0.05)。 结论新型颅脑穿刺定位器结合新型头颅CT定位贴片辅助软通道穿刺引流术治疗高血压脑出血可以提高穿刺定位准确性及颅内血肿清除率,减少术中出血量,从而改善患者预后,提高生存质量,适宜在广大基层医院开展。  相似文献   

18.
目的探讨血肿穿刺引流加脑室外引流高血压脑出血的治疗方法。方法对89例高血压脑出血破入脑室行血肿及脑室同时穿刺外引流加尿激酶注入治疗临床资料的分析。结果 89例患者术后6个月随访,生活能自理者32例;基本能自理者25例;不能自理者22例;植物生存者7例;死亡3例。结论高血压脑出血破入脑室,采取血肿及脑室穿刺外引流加术后尿激酶注入溶解的治疗方法,一般3~5 d血肿基本消失,手术创伤小,恢复快。  相似文献   

19.
双靶点微创治疗丘脑出血破入脑室并发脑积水   总被引:3,自引:0,他引:3  
目的探讨高血压丘脑出血的微创治疗方法。方法回顾性分析10例高血压丘脑出血破入脑室伴脑积水的病例资料,采用已取得专利的立体定向微创器械,以双靶点软通道微创穿刺引流,同时行丘脑血肿和脑室微创穿刺引流,术后辅以尿激酶灌洗治疗。临床评价标准包括血肿清除率、脑积水缓解率、手术时间、术后再出血、颅内感染率、30 d病死率及术后随访1-24个月GOS。结果术后病人平均血肿清除率为(90.0±1.6)%,脑积水缓解率90%,平均手术时间(25.6±4.8)min,无血肿腔再出血,发生颅内感染2例,30d病死率10%。术后随访1-24个月,GOS5分3例,4分3例,3分1例,2分1例,1分2例。结论双靶点软通道微创穿刺引流治疗丘脑出血破入脑室伴脑积水具有操作简单、安全、有效、创伤小的特点。  相似文献   

20.
血肿穿刺抽吸术治疗高血压性脑出血58例临床分析   总被引:1,自引:0,他引:1  
目的 探讨超早期微创术治疗高血压性脑出血的疗效和影响疗效的主要因素。方法 回顾性分析微创术治疗58例高血压性脑出血患者的术后疗效。结果 58例患者完全康复8例,生活完全自理27例。部分自理11例,需他人照料5例,死亡7例。结论 微创术超早期治疗高血压性脑出血安全、有效、病死率低、致残率低、预后好。  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号