高血压脑出血伴天幕裂孔疝手术治疗的临床研究

目的探讨对比标准大骨瓣开颅（Standardlargecraniotomy）血肿清除去大骨瓣减压并天幕裂孔疝复位术与常规大骨瓣开颅血肿清除去大骨瓣减压术对高血压脑出血伴天幕裂孔疝的治疗效果。方法66例高血压脑出血伴天幕裂孔疝患者（格拉斯哥昏迷评分GCS≤8分）随机分成研究组（标准大骨瓣开颅）和对照组（常规大骨瓣开颅），术后记录1、3、7d腰穿置管监测颅内压（intracranialpressureICP）值、脑脊液细胞数、头颅cT检查并测量脑水肿范围和中线结构移位、TCD（transcranialdopplersystem）监测脑血管痉挛等指标，根据主要并发症比较两组疗效。结果术后3d研究组较对照组的颅内压、脑脊液细胞数、脑水肿范围和中线结构移位等指标改善有显著性差异（P〈0．01）。术后7d研究组的上述各项指标接近正常。研究组并发症和死亡率明显少于对照组。结论用标准大骨瓣开颅血肿清除去大骨瓣减压并天幕裂孔疝复位术治疗高血压脑出血伴天幕裂孔疝能减少并发症．降低死亡率，是手术治疗高血压脑出血伴天幕裂孔疝的有效方法。

Clinical Study on Operation of Hypertensive lntracerebral Hemorrhage with Tentorial Hernia

Objective To investigate and compare the therapeutic effect between using the standard large eraniotomy hematoma removal of large craniectomy with atrium hernia reposition and conventional large craniotomy bematoma removal of large decompressive craniectomy in the treatment of hypertensive intracerebral hemorrhage with tentorial hernia.Methods 66 cases of hypertensive intracerebral hemorrhage associated with tentorial hiatus hernia （GCS ≤ 8 score） were randomly divided into study group （treated with standard large craniotomy） and control group （treated with conventional large craniotomy）. On 1 d, 3 d and 7 d after the surgery, the results for ICP measurement of intracranial pressure by spinal puncture, cerebrospinal fluid cell count, the head CT of brain edema and midline shift range and TCD monitoring of cerebral vasospasm were recorded.Efficacy was compared according to major complications. Results 3 d after the surgery the intracranial pressure, cerebrospinal fluid cell count, cerebral edema and midline shift range of the study group improved significantly compared to control group （P〈0.01）. After 7 d the indicators for the study group were close to normal. The mortality rate for study group was 27% whereas the mortality rate of control group was 39% .The re-cerebral hemorrhage after craniectomy was not significant compared to control group （P〉0.05）. Conclusion Using standard large craniotomy hematoma removal to large craniectomy and atrium hernia reposition can reduce complications and mortality rate in surgical treatment of hypertensive intracerebral hemorrhage associated with tentorial hernia in an effective manner.