颅内血肿微创清除术92例分析

目的探讨微创手术对颅内血肿的治疗效果。方法采用颅内血肿粉碎穿刺针治疗各类颅内血肿92例。其中高血压脑出血72例,急性硬膜外血肿4例,慢性硬膜下血肿16例。结果本组死亡6例,均为高血压脑出血,无二次出血病例。生存的病例术后6个月随访,用ADL（日常生活能力）评定疗效,ADL1（恢复日常生活）硬膜外血肿及慢性硬膜下血肿20例,高血压脑出血20例;ADL2（生活自理）28例;ADL3（生活需要帮助,可扶行）20例;ADIA（卧床,有意识）4例;ADL5（植物状态）无。本组治疗良好率92％。结论微创治疗脑出血疗效确切,手术创伤小,远期功能恢复满意。     

密闭式颅内血肿引流冲洗器在高血压性脑出血穿刺引流中的应用价值

目的探讨密闭式颅内血肿引流冲洗器在高血压性脑出血穿刺引流中的应用价值。方法根据CT定位,锥颅置入密闭式颅内血肿引流冲洗器的颅内引流管,再外接密闭式引流器的颅外部分,使用该引流器的塑料吸球自动抽吸和三通管的丁基胶帽在完全密闭的情况下注入尿激酶等血凝块溶化药物,通过调节滴壶的高度进行持续抽吸引流,治疗高血压性脑出血35例。结果住院40～65d。出院时治愈6例,显著进步11例,进步13例,总有效率86%（30/35）;死亡5例,死亡率14%。血肿清除时间1～3.5d,平均2.7d。再出血3例,发生率为9%。无气颅、颅内外感染。生存的30例随访3～6个月,日常生活能力（ADL）分级,Ⅰ级7例,Ⅱ级8例,Ⅲ级12例,Ⅳ级3例。结论使用密闭式颅内血肿引流冲洗器,治疗程序简便,血肿清除快,治疗效果满意。     

微创穿刺颅内血肿清除术治疗高血压脑出血21例

目的探讨微创穿刺引流术治疗高血压脑出血的临床效果。方法回顾分析微创穿刺颅内血肿清除术治疗高血压脑出血21例患者的临床资料。结果无1例发生颅内感染。初步清除率40.8%～75.2%,平均56.5%。术后1周复查CT,血肿消失达90%,其余均在手术后2周消失。出院后随访1～3个月,生存19例,占90.5%,死亡2例。结论微创穿刺颅内血肿清除术治疗高血压脑出血,效果显著,值得推广。     

多点对冲引流治疗外伤性颅内血肿

目的探讨多点对冲引流治疗外伤性颅内血肿的疗效. 方法 2003年2～9月我院应用YL-1型一次性颅内血肿粉碎穿刺针同时进行2～3针穿刺对冲引流治疗28例外伤性颅内血肿. 结果治愈25例,治愈率89.3%(25/28),改开颅手术3例,其中死亡2例. 结论多点对冲引流治疗外伤性颅内血肿微创、安全、有效.     

多点锥颅治疗高血压性脑出血

目的 探讨多点锥颅抽吸引流治疗高血压性脑出血的疗效。方法 根据CT不同的出血量采用不同数量的靶点在局麻下进行锥颅抽吸、尿激酶灌注冲洗引流治疗高血压性脑出血67例。结果 住院死亡22例（32.8%）,其中4例术后3 d内由于脑干功能衰竭死亡,12例术后合并肺部感染、上消化道出血死亡,6例术后血肿扩大、改行开颅术后死亡。余45例随访10～12个月,以ADL为疗效指标,1级5例,2级9例,3级14例,4级8例,5级3例;随访期间死亡6例,其中2例死于颅内再次出血,3例合并肺部感染死亡,1例死因不明。结论 多点锥颅治疗高血压性脑出血,效果满意,尤其适用于出血量较大或年老体弱不能适于开颅手术者。     

微创术治疗高血压脑出血40例

目的 观察颅内血肿微创清除术治疗高血压性脑出血的疗效.方法 对40例高血压性脑出血患者,采用YL-1型一次性颅内血肿粉碎穿刺针经皮穿颅清除血肿.结果 经过治疗,40例高血压性脑出血患者血肿清除率为80%～100%,存活率为92.5%.结论 利用YL-1型一次性颅内血肿粉碎穿刺针微创清除术治疗高血压性脑出血效果显著,值得...     

微创颅内血肿清除术治疗高血压脑出血体会

目的观察微创颅内血肿清除术治疗高血压脑出血的效果。方法对30例高血压脑出血患者实施微创颅内血肿清除术,回顾性分析患者的临床资料。结果本组治愈12例,显效10例,有效6例,无效2例(死亡1例,植物人状态1例),总有效率93.33%(28/30)。结论微创颅内血肿清除术治疗高血压脑出血,具有预后好,并发症少,效果满意。     

高血压性脑出血的微创穿刺治疗

目的探讨微创穿刺引流术治疗高血压性脑出血的疗效。方法根据CT定位确定穿刺点、穿刺方向及穿刺针长度,电钻将YL-1型一次性颅内血肿穿刺针送入血肿靶点,抽吸血肿后,血肿腔内分次注入尿激酶溶解引流出残存血肿,动态复查CT了解血肿清除情况并结合病人临床症状择期拔针。结果死亡33例,病死率18.3%(33/180)。随访64例,3~6个月后按日常生活能力(activity of dailylife,ADL)分级评定,ADL1级12例,ADL2级20例,ADL3级24例,ADL4级6例,ADL5级2例。结论微创穿刺引流术治疗高血压性脑出血简便、快捷、创伤小、疗效好。     

微创清除颅内血肿的临床治疗体会

目的总结微创清除颅内血肿的治疗。方法我科于1999年6月以来用3mm直径YL-1型颅内血肿粉碎穿刺针治疗颅内血肿,经过对血肿的抽吸冲洗,血肿逐步液化流出而达到清除颅内血肿的目的。结果多数病例在术后5天内拔针,脑室外引流可根据情况保留10-15天。一般脑内血肿清除率在80％以上,硬脑膜外血肿清除率在90％以上,而慢性硬脑膜下血肿清除率更高达95％以上。患者昏迷时间缩短,恢复快,致残率降低。术后生活能力方面以急性硬脑膜外血肿和慢性硬脑膜下血肿效果最佳,均为Ⅰ级,高血压脑出血中Ⅰ级12例,Ⅱ级5例,Ⅲ级3例,Ⅳ级2例,良好率为76％,死亡率16％。结论微创颅内血肿清除术适用于病情相对稳定,昏迷但无瞳孔异常改变或无明显脑疝的外伤性颅内血肿以及高血压脑出血、脑室出血的患者。其操作方便简单,创伤小,效果好。值得临床推广普及。     

微创综合治疗高血压脑出血

目的 研究高血压脑出血的微创治疗方法。方法 对90例进行微创治疗的疗效进行分析（ADL评分），评估治疗效果。结果 81例（除外9例手术患者）中术后1个月内死亡12例（15％），5例死亡坠积性肺炎，2例死于应激性溃疡出血，5例死于多器官功能衰竭。其中8例为双侧瞳孔散大者。69例存活者随访3个月-2年，采用ADL分级，1级18例，2级16例，3级14例，4级13例，5级8例。结论 锥颅血肿腔穿刺引流及尿激酶注入治疗脑出血操作简单、创伤小，值得在基层医院推广运用。     

一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗体会

目的 探讨一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗方法.方法 回顾性分析13例急性颅内血肿术中继发对侧迟发性颅内血肿患者的临床资料,采用一次开颅清除双侧血肿.结果 术后按Glasgow(COS)评定预后,其中良好4例,中残4例,重残2例,植物生存1例,死亡2例.结论 采用一次开颅治疗一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的效果显著,可以提高患者的生存率和生活质量.     

一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗体会

目的 探讨一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的治疗方法.方法 回顾性分析13例急性颅内血肿术中继发对侧迟发性颅内血肿患者的临床资料,采用一次开颅清除双侧血肿.结果 术后按Glasgow(COS)评定预后,其中良好4例,中残4例,重残2例,植物生存1例,死亡2例.结论 采用一次开颅治疗一侧急性颅内血肿清除术中继发对侧迟发性颅内血肿的效果显著,可以提高患者的生存率和生活质量.     

体外循环开心术后并发颅内出血

8例心脏病患者体外循环开心术后并发颅内出血或血肿，发生率为0．28％。其中硬膜下血肿4例，脑内血肿3例，蛛网膜下腔出血1例。6例死亡，2例存活，随访半年情况良好。对于体外循环心脏手术患者，应警惕颅内血肿发生并及时首选头部CT检查，正确把握开颅手术适应证。     

额部钻颅血肿引流术治疗高血压基底节区脑出血109例

目的 探索一种新的手术方法治疗高血压脑出血,既能避开重要功能区及重要血管分布区,又能达到与其他穿刺术式引流效果相仿. 方法 回顾性分析我科2010年8月至2011年10月行新术式穿刺的高血压脑出血患者109例,所有患者均经头颅CT确诊,根据多田公式计算出血量,分别采用局麻或全麻下额部钻颅软通道引流血肿78例,额部钻颅血肿引流配合脑室外引流20例,单纯行脑室外引流术11例. 结果 术后2～5d复查头颅CT示:血肿完全清除19例;血肿清除90％以上37例,血肿清除80％以上43例,清除50％以上8例,血肿清除小于50％2例;未发生切口及颅内感染;术后死亡6例. 结论 额部钻颅血肿引流术治疗高血压基底节区脑出血能有效避免对重要脑组织的损伤,减少手术并发症;血肿清除率高,提高了患者的生存率和生存质量.     

重型颅脑损伤后迟发性颅内血肿预后分析

目的研究重型颅脑损伤后迟发性颅内血肿的生存时间及预后特点.方法对本院2003年1月至2004年4月收治ICU的66例重型颅脑损伤患者进行回顾性分析,分析其生存时间,并比较迟发性颅内血肿组和非迟发性血肿组的生存时间.结果本组病例总生存率为54.54%,非迟发性血肿组生存率为66.67%.迟发性血肿组为45.16%,非迟发性血肿组平均生存时间为60.17天,迟发血肿组为40.86天,两者有统计学差异(P＜0.05)结论重型颅脑损伤后迟发性颅内血肿患者的死亡率比非迟发性颅内血肿患者要高,早期诊断,早期治疗可能是改善其预后的重要方法.     

Clinical significance of intracranial hemorrhage caused by cerebral arteriovenous malformations: with special reference to intraventricular hemorrhage

Forty-two cases with intracranial hemorrhage caused by cerebral arteriovenous malformation (AVM), which was diagnosed by CT scan, were reviewed with regard to the clinical significance of intracranial hemorrhage, especially intraventricular hemorrhage (IVH). Twenty-one patients were defined as poor risk cases whose level of consciousness at admission was 100 to 300 according to the Japan Coma Scale, whereas the remaining 21 patients were defined as good risk cases. Surgical excision of AVM was undertaken in 35 out of the 42 cases. Urgent surgical removal of intracerebral hematoma and AVM within 24 hours following onset was undertaken in 11 cases. In 14 patients, urgent continuous ventricular drainage was carried out. The effects of the following factors on the level of consciousness at admission, and on the result of AVM treatment were investigated to clarify the clinical significance of intracranial hemorrhage; 1) cast formation of 3rd and/or 4th ventricle, 2) volume of intraventricular hematoma, 3) accompanying intracerebral hematoma and 4) acute hydrocephalus. It was confirmed that all these factors significantly contributed to the development of serious disturbance of consciousness in the acute stage following intracranial hemorrhage. For good risk cases, the rate of patients who showed a good recovery or only moderate disability according to the Glasgow Outcome Scale reached 91%, whereas for poor risk cases, it was only 43%. The presence of large intracerebral hematomas of more than 4 cm in diameter accompanied with IVH was significantly correlated with the result of AVM treatment. The presence or absence of cast formation of 3rd and/or 4th ventricle, volume of intraventricular hematoma and acute hydrocephalus were not significantly related to the result of AVM treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rapid natural resolution of intracranial hematoma

To investigate the clinical characteristicsof intracranial hematoma and the mechanism involved in itsrapid natural resolution.     

单额开颅治疗双额叶挫裂伤伴血肿

目的总结单额开颅治疗双额叶挫裂伤的经验。方法回顾性分析21例双额叶挫裂伤患者的临床资料,均采用单额开颅治疗。入院时GCS评分:9～11分13例,6～8分6例,3～5分2例。结果术后第1 d所有病例均行头颅CT复查,无一例出现迟发性颅内血肿或残余血肿。对侧挫裂伤及血肿基本清除(>75%)15例,部分清除(50%～75%)6例。术后6个月按GOS分级标准,恢复良好13例,中残4例,重残3例,死亡1例。结论采用单额开颅能有效清除双额叶挫裂伤及血肿,并具有缩短手术时间、减轻手术创伤等优点,具有较好的临床实用价值。     

Computerized transverse axial tomography in intracerebral, intracerebellar and intraventricular hemorrhage (author's transl)

Computerized transverse axial tomography (CT) of the brain is a recently developed method which allows non-invasive roentgenologic evaluation of intracranial diseases. The advent of CT represents a great advance in the diagnosis of a very wide variety of intracranial lesions, including cerebrovascular diseases. Especially, CT was found to be extremely informative in evaluating intracerebral, intracerebellar and intraventricular hemorrhage. The purpose of this report is to evaluate the clinical usefulness of CT in the diagnosis of intracranial hemorrhage. From the seven hundreds cases of various intracranial diseases hitherto examined by the EMI-scanner (160 X 160 matrix), twenty-three cases of nontraumatic intracranial hemorrhage were selected for the present study. Fifteen cases of fresh hemorrhage consisted of hypertensive cerebrovascular disease, arterio-venous malformation, aneurysm and unknown etiology, number of cases being six, three, four and two, respectively. All cases were examined within fifteen days after the ictus and the positive findings were obtained in all cases. The characteristic feature of the hematoma is the circumscribed and increased density area surrounded by the decreased density zone probably representing the accompanied brain edema. The sequential CT studies revealed that the hematoma area was gradually decreased in its density and finally transformed into the rather low density one in four weeks or so after the ictus. The smallest hematoma detected by CT was the cerebellar hematoma about five grams in weight, which was failed to be recognized by the angiography. In cases of the old hemorrhage, besides the decreased density area of the hematoma, such findings were obtained as cerebral atrophy, ventricular dilatation and porencephalic change. It would be concluded that CT study is the most useful aid at present available in the diagnosis of intracranial hemorrhage. The precise anatomic extent of the hematoma, associated brain edema, ventricular deformity and displacement and hydrocephalus are all readily assessed by CT.     

迟发性外伤性颅内血肿30例分析

目的总结迟发性外伤性颅内血肿(DTICH)的诊治经验。方法患者均头部CT检查,首次检查于伤后1～3 h。正常8例,脑挫裂伤伴血肿9例,硬膜下血肿6例,硬膜外血肿7例,颅内积气5例。复查头部CT发现血肿时间22例于伤后3～6 h,4例于伤后3～7 d,4例伤后7d以后发现。其中脑内血肿22例(额叶10例、颞叶12例),硬膜下血肿6例,硬膜外血肿2例。血肿与受力点关系,直接着力12例,对冲部位18例。迟发性颅内血肿指首次检查(CT扫描)未发现,经过一定时间后复查发现的血肿,或手术、尸检在原无血肿部位发现血肿。其产生的机理尚不清楚。结果 30例中14例有颅骨骨折及硬脑膜中动脉破裂,5例原发血肿,11例迟发性血肿发生在颅骨骨折部位。可能与血肿清除后填塞现象解除及骨折线渗血加速有关。结论对有颅骨骨折的颅内血肿患者,如血肿不在骨折线附近,或骨折线较长,原发血肿位于骨折线的一端,血肿清除后,颅内压仍高或脑膨出者,首先应排除远隔部位骨折线附近迟发血肿的可能。