微创血肿清除术治疗高血压脑出血疗效观察

目的探讨微创定向穿刺碎吸术治疗高血压脑出血的疗效。方法将72例患者随机分为微创组36例和内科保守治疗组(保守组)36例,比较2组预后,并针对手术时机和液化剂不同剂量进行分组比较。结果微创组病死率明显低于对照组。与保守组相比,微创组神经缺损功能评分显著下降,格拉斯哥昏迷评分(GCS)明显升高;早期治疗组(6～12 h)的GCS评分改善优于晚期治疗组(12～72 h);低剂量尿激酶(5 000～20 000 IU)治疗90 d预后与高剂量尿激酶组(尿激酶2万～5万IU,部分加用肝素)相比,各项评分均无显著性差异。结论微创穿刺碎吸术治疗高血压脑出血简便易行,安全可靠,经济实用,疗效可靠,早期、合理应用液化剂是关键。

Observation of curative effect of minimally invasive surgery on hypertensive cerebral hemorrhage

Objective It is to investigate the efficacy of minimally invasive brain surgery to remove directional hematoma of hypertensive cerebral hemorrhage.Methods 72 patients were randomly divided into minimally invasive surgery group(36 cases) and medical conservative therapy group(36 cases),the prognosis of the two groups was compared,and the influence of the different operation time and liquefied agent doses for surgical group was compared.Results The mortality of minimally invasive group was obviously lower than that of conservative therapy group.Compared with the conservative group,the surgical group’s nerve defects functional score(NIHSS) declined significantly and the Glasgow coma scale(GCS) score increased significantly.Early period treatment(6~12 h) group’s GCS score was better than the late treatment group(12~72 h);there was no significant different prognosis between the low doses urokinase(5 000~20 000 IU) group and high doses urokinase(20 000~50 000 IU,some patients added with heparin) group.Conclusion Minimally invasive surgery for evacuation of hypertensive cerebral hemorrhage is very easy,safe,economical and practical,early and rational application of the liquefied agent is the key factor.