极重型基底节脑出血神经内外科疗效的比较

目的探讨极重型基底节脑出血患者的神经内外科治疗效果，总结相应的手术适应证。方法统计金谷分类IVb级和V级基底节脑出血患者（各100例）神经内外科治疗效果，采用高血压重症基底节-丘脑血肿CT分型法探讨影响疗效的相关因素。结果手术治疗组总病死率为62％（62／100），低于保守治疗组的92％（92／100；X2=23．744，P=0．000）；CT分型Ⅲ～Ⅴ型患者总病死率为84．21％（32／38），高于Ⅰ-Ⅱ型的48．39％（30／62；Fisher精确概率法：P=0．000）；开颅手术组患者总病死率为54．41％（37／68），低于非开颅手术组的78．13％（25／32；X2=7．920，P=0．048）。结论金谷分类IVb级极重型基底节脑出血患者应积极施行手术治疗，而Ⅴ级患者应慎行手术，需结合患者年龄（〈60岁）、脑疝症状出现时间（发病时间〉12h）、CT分型（Ⅰ～Ⅱ型）及是否伴有全身性疾病（无心、肺、肝、肾等重要脏器疾病和糖尿病）等多项因素综合考虑，制定治疗方案。

Curative effects of neurosurgical and neurological treatment on severe basal ganglia hemorrhage

Objective To compare the curative effects of neurosurgical and neurological treatment on severe basal ganglia hemorrhage, and to propose the operation indications. Methods One hundred cases according with JinGu level IWb and Ⅴwere treated with operation or non-operation. All cases were accorded with the standard of hypertensive severe basal ganglion and thalamus hematoma level in CT imaging. SPSS 10.0 software was used for statistical analysis. Results The total case-fatality rate in operation group and non-operation group was 62%（62/100） and 92%（92/100）, respectively （X2= 23.744, P = 0.000）. The total case-fatality rate of Ⅲ-Ⅳ level in CT imaging group and Ⅰ-Ⅱlevel in CT imaging group was 84.21% （32/38） and 48.39%（30/62）, respectively （P = 0.000）. The total case-fatality rate in craniotomy operation group and non-craniotomy operation group was 54.41%（37/68） and 78.13%（25/32）, respectively （X2 = 7.920, P = 0.048）. Conclusion Patients with JinGu level Ⅳh of severe basal ganglia hemorrhage should be operated actively. Patients in JinGu level Ⅴgroup should be operated cautiously referred with the following factors： age （〈 60 years old）; brain hernia occurrence time （onset time 〉 12 h）; level in CT imaging （ Ⅰ-Ⅱlevel）; systemic disease no major visceral （heart, lung, liver, kidney） disease and diabetes].