血肿腔钻孔联合侧脑室置管引流治疗老年性高血压脑出血的临床研究(附168例报道)

目的 探讨血肿腔钻孔联合侧脑室置管引流治疗老年性高血压脑出血的临床效果.方法对解放军第四七四医院神经外科自2002年3月至2009年2月收治的168例老年性高血压脑出血患者应用血肿腔钻孔联合侧脑室置管引流加尿激酶溶解血肿的方法进行治疗,术后随访6～12个月,根据GOS评分评价患者治疗效果,并分别对患者术前意识分级、出血量大小与预后程度关系进行统计学分析.结果 本组患者预后良好91例,轻残41例,重残及植物生存13例,死亡23例,术后并发症较少.术前意识分级Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组、出血量30～70 mL组和70 mL以上组患者预后差异有统计学意义(P＜0.05),平均秩次比较显示Ⅰ～Ⅱ级组患者疗效明显优于Ⅲ～Ⅳ级组,30～70mL组患者疗效明显优于70mL以上组.结论 血肿腔钻孔联合侧脑室置管引流加尿激酶溶解血肿是治疗老年性高血压脑出血的有效方法.

Abstract：

Objective To explore the clinical treatment efficacy of punch drainage combined with ventricle puncture in patients with senile hypertensive hemorrhage. Methods One hundred and sixty-eight patients with senile hypertensive hemorrhage, admitted to our hospital from March 2002 to February 2009, were treated by punch drainage combined with ventricle puncture and hematoma dissolution with urokinase. Meanwhile, follow-up for 6-12 months was performed to every patient; the postoperative treatment effects and complications were evaluated by Glasgow Outcome Scale; the relations between the prognosis and both the amount of intracerebral hemorrhage and grades of consciousness situation were statistically analyzed. Results Good prognosis was noted in 91 patients,mild disability in 41, severe disability and vegetative state in 13, and death in 23; few postoperative complications were noted. The prognoses were significantly different in patients with different amounts of intracerebral hemorrhage; so are those in patients with different grades of consciousness situation (P＜0.05); the prognosis of patients under grade Ⅰ-Ⅱ consciousness situation was better than that of patients under grade Ⅲ-Ⅳ consciousness situation and the prognosis of patients with hemorrhage between 30-70 mL was obviously better than that of patients with hemorrhage above 70 mL. Conclusion The punch drainage combined with ventricle puncture and hematoma dissolution with urokinase is an effective treatment method for patients with senile hypertensive intracerebral hematoma.

Treatment of senile hypertensive hemorrhage with punch drainage and lateral ventricle puncture: a report of 168 cases

Objective To explore the clinical treatment efficacy of punch drainage combined with ventricle puncture in patients with senile hypertensive hemorrhage. Methods One hundred and sixty-eight patients with senile hypertensive hemorrhage, admitted to our hospital from March 2002 to February 2009, were treated by punch drainage combined with ventricle puncture and hematoma dissolution with urokinase. Meanwhile, follow-up for 6-12 months was performed to every patient; the postoperative treatment effects and complications were evaluated by Glasgow Outcome Scale; the relations between the prognosis and both the amount of intracerebral hemorrhage and grades of consciousness situation were statistically analyzed. Results Good prognosis was noted in 91 patients,mild disability in 41, severe disability and vegetative state in 13, and death in 23; few postoperative complications were noted. The prognoses were significantly different in patients with different amounts of intracerebral hemorrhage; so are those in patients with different grades of consciousness situation (P＜0.05); the prognosis of patients under grade Ⅰ-Ⅱ consciousness situation was better than that of patients under grade Ⅲ-Ⅳ consciousness situation and the prognosis of patients with hemorrhage between 30-70 mL was obviously better than that of patients with hemorrhage above 70 mL. Conclusion The punch drainage combined with ventricle puncture and hematoma dissolution with urokinase is an effective treatment method for patients with senile hypertensive intracerebral hematoma.