高血压脑室型丘脑出血18例微创治疗分析

目的探讨高血压脑室型丘脑出血微创治疗的疗效。方法 2007-08-2009-12采用丘脑穿刺联合脑室穿刺及腰穿引流治疗18例脑室型丘脑出血。结果术后存活16例,死亡2例。3例在穿刺术后12 h内清醒,2例脑疝在危急情况下,采用双针微创穿刺引流后均死亡。术后日常生活能力（activitiesofdailyliving,ADL）分级：1级3例,2级7例,3级5例,4级1例,死亡2例。16例术后3个月随访病情稳定,无复发;1例术后随访3 a,已完全康复。结论局麻下丘脑穿刺联合脑室穿刺及腰穿引流治疗高血压脑室型丘脑出血创伤小,操作简便,疗效满意。     

小骨窗开颅与微创治疗高血压脑出血的临床对比研究

高血压脑出血（hypertensive intracerebralhemorrhage,HICH）作为中老年人临床上常见的一种危重疾病,特点是起病急,病情进展迅速,病死率及致残率较高。我院神经外科采用微创颅内血肿穿刺引流术治疗HICH 66例,效果满意,结果报道如下。1 资料与方法1．1病例选择2008年1月至2010年7月我科收治HICH患者144例,发病后均伴有意识障碍和不同程度的偏瘫。     

颅内血肿微创清除术治疗高血压性脑出血85例观察

目的探讨颅内血肿微创清除术治疗高血压性脑出血(HICH)的临床疗效。方法住院治疗的85例HICH患者,随机分为两组,治疗组43例采用颅内血肿微创清除术治疗,对照组42例采用传统开颅术治疗,对比观察两组的临床疗效。结果近期疗效比较,治疗组的总有效率为86.0%明显高于对照组的50.0%,而治疗组的死亡率为2.3%明显低于对照组的11.9%,差异均有统计学意义(P<0.05)。远期疗效比较,治疗组的优良率为73.9%,明显高于对照组的40.5%,而治疗组的死亡率为2.4%明显低于对照组的10.8%,差异均有统计学意义(P<0.05)。采用颅内血肿微创清除术治疗HICH首次清除率为42.3%~91.3%,平均54.6%,总清除率为71.5%~98.1%,平均80.6%。术后一周复查头颅CT,血肿完全消失者占83.7%。结论颅内血肿微创清除术具有简单、快速、创伤小、术后并发症少等优点,可明显提高患者的生存率、降低死亡率。     

急诊微创手术治疗高血压脑出血的临床观察

2006年1月至2008年12月河北省清河县第二医院神经内科对53例高血压脑出血患者行急诊微创手术清除血肿,预后较好,现报道如下.     

重症高血压基底节出血经岛阈后入路治疗体会

目的：探讨分析重症高血压基底节出血经岛阈后入路的手术治疗经验。方法：回顾性分析12例采用经岛阈后入路病人的手术效果，与同期常规经颞上回或颞中回入路开颅47例此类病人进行对比，分析有关文献。结果：12例病人的手术效果明显优于常规开颅手术方法。结论：治疗重症高血压基底节出血宜采用此术式。     

微创穿刺引流联合开颅手术治疗重型高血压脑出血

重型高血压脑出血是急性脑血管病中病死率和致残率最高的疾病,尤其出血量>60 ml并发脑疝患者的病死率更高。我科2008年1月～2009年6月采用开颅手术联合微创穿刺引流术抢救高血压脑出血20例,现报告如下。1临床资料1.1一般资料本组20例均符合全国第四届脑血管病学术会议制定的重型高血压脑出血诊断标准,并排除动脉瘤、动静脉畸形等其他脑实质出血性疾病。男12例,     

微创手术治疗高血压小脑出血38例分析

目的:通过对高血压小脑出血微创手术经过及治疗效果的介绍,拓宽小脑出血的治疗方法.方法:对38例高血压小脑出血微创手术效果进行分析总结.结果:38例微创术后患者按GOS预后评价:Ⅰ级5例,Ⅱ级5例,Ⅲ级9例,Ⅳ级10例,Ⅴ级9例.结论:微创手术是治疗高血压小脑出血的一种操作简单,效果可靠的方法,拓宽了手术适应证.     

微创手术治疗高血压脑出血疗效观察及其再次出血的影响因素研究

[目的]比较研究立体定位联合微创手术治疗高血压脑出血患者的疗效,探讨高血压脑出血术后再出血的危险因素.[方法]回顾性分析2014年1月至2016年1月本院神经外科科收治的80例高血压脑出血患者的临床资料,根据手术方法的不同将其分为观察组和对照组,每组各40例.观察组采用立体定位联合微创手术,对照组采用常规大骨瓣开颅手术,比较两组疗效,并采用多因素Logistic回归分析术后再出血危险因素.[结果]观察组患者手术时间、血肿吸收时间、下床活动时间和住院时间均短于对照组,术中出血量、血肿大小均小于对照组,差异均具有统计学意义(均P＜0.05).观察组患者的神经功能缺失评分为(7.5±2.5)分,显著低于对照组的(11.6±2.6)分差异具有统计学意义(t=4.05,P＜0.05).观察组术后再出血、上消化道出血、中枢性高热的发生率为2.5％(1/40),显著低于对照组的22.5％ (9/40),差异有统计学意义(x2=5.36,P＜0.05).患者同时伴有糖尿病、凝血功能异常、血肿破入脑室、血肿＞40.0 mL、出血部位为基底节区、血肿形状不规则是高血压脑出血术后再出血的危险因素,均具有统计学差异(均P＜0.05,OR＞1);其中凝血功能异常、出血部位为基底节区和血肿形状不规则是高危因素(OR＞2).患者是否伴有冠心病和立体定位联合微创手术是再出血的保护因素(P＜0.05,OR ＜1).[结论]与传统术式相比,立体定位联合微创手术治疗高血压脑出血具有手术时间短、术中出血量少、下床时间早、住院时间短、并发症少和神经功能缺失少等优点,为减少再出血应控制危险因素,尤其注意高危因素,如凝血功能异常、出血部位和血肿形状等.     

高血压脑出血患者的手术治疗：手术时机与预后

目的探讨超早期和早期手术对老年组和中年组高血压脑出血（ICH）患者预后的影响。方法高血压脑出血患者分为老年组（60～83岁,57例）和中年组（39～59岁,46例）。老年组中26位患者（45．6％）及中年组中22位患者（47．8％）行超早期手术治疗（发病7h内）;而老年组中31位患者（54．4％）及中年组中24位患者（52．2％）则接受了早期手术治疗（发病7．48h）。术后通过日常生活能力评分表（ADL）对患者的预后进行χ^2分析及评价。结果在老年组患者中,超早期手术的病死率较早期手术低（7．0％VS32．2％,χ^3=5．134,P〈0．05）。经超早期手术的患者中ADL评分为Ⅰ级的为12人,明显高于经早期手术的6人（46．1％vs19．3％,χ^2=4．7,P〈0．05）。尽管如此,在中年组患者中,超早期和早期手术的预后无明显差别。结论对于老年高血压脑出血患者,与早期手术相比,超早期手术可获得更好的预后。但此结论不适于中年高血压脑出血患者。     

影响高血压脑出血微创治疗短期预后的相关因素分析

目的探讨高血压脑出血微创穿刺治疗的短期预后影响因素,以期改善患者的预后。方法回顾性分析新疆维吾尔自治区人民医院神经外科于2011年3月至2014年12月经微创穿刺治疗的117例高血压脑出血患者的临床资料,包括年龄、既往高血压病史、术前收缩压、术前血糖值、术前格拉斯哥昏迷评分(GCS)、出血部位、血肿形态、出血量、手术时机、脑室积血、中线移位、术后再出血、二次手术、肺部感染及电解质紊乱的临床资料,应用日常生活能力(ADL)评分来评判患者术后1个月预后情况。单因素分析采用χ2检验;将单因素分析中对预后有统计学意义的影响因素引入多元逻辑回归模型,分析这些影响因素与预后的相关性。结果单因素分析显示,年龄、术前收缩压、术前血糖值、术前GCS评分、出血部位、出血量、从发病至手术时间、脑室积血、中线移位、术后再出血、二次手术、肺部感染对预后的影响具有统计学意义(P<0.05)。多因素Logistic回归性分析结果提示,该类患者术后1个月预后的独立影响因素是年龄(OR=4.153,95%CI 1.346~12.815,P=0.013)、术前血糖(OR=4.813,95%CI 1.181~19.768,P=0.028)、术前GCS评分(OR=0.112,95%CI 0.150~0.885,P=0.035)、血肿量(OR=5.113,95%CI 1.170~22.338,P=0.030)、脑室积血(OR=0.075,95%CI 0.006~0.955,P=0.046)、二次手术(OR=0.052,95%CI 0.003~0.951,P=0.046)、肺部感染(OR=0.192,95%CI 0.051~0.723,P=0.015)。结论影响高血压脑出血微创治疗的预后因素众多且复杂,在临床中我们若能对这些因素加以干涉和治疗很有可能有益于患者病情恢复并改善预后。     

微创穿刺清除术在基底节区脑出血治疗中的临床应用

目的探讨微创穿刺血肿清除术治疗基底节区高血压脑出血的临床疗效。方法选取行微创穿刺血肿清除术治疗的高血压基底节区脑出血患者61例作为观察组,选取同期行内科保守治疗的高血压基底节区脑出血患者47例作为对照组。比较两组患者神经功能恢复情况、血肿清除率、日常生活活动能力及死亡情况。结果微创穿刺清除术患者治疗3周后神经功能缺损评分、血肿清除率及治疗后3个月的日常生活活动能力恢复情况均明显优于对照组(P0.05)。微创穿刺清除术患者的病死率略低于对照组,差异无统计学意义(P0.05)。结论微创穿刺引流术治疗基底节区脑出血手术创伤小、血肿清除率高,有利于患者神经功能缺损的恢复。     

高血压脑出血微创手术治疗临床分析

目的探讨微创手术规范化治疗高血压脑出血的原则和方法。方法应用小切口微创手术对49例高血压脑出血患者行血肿清除术。结果本组术后存活46例,死亡3例。随访42例,按格拉斯哥治疗结果分级,良好19例,中残但生活能自理12例,重残、意识清醒但生活不能自理5例,植物生存3例,死亡3例。结论正确运用微创手术理念,依据病情特点进行个体化、规范化治疗,可明显提高术后疗效。     

Short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage

BACKGROUNDHypertensive intracerebral hemorrhage is a common critical disease of the nervous system, comprising one fifth of all acute cerebrovascular diseases and has a high disability and mortality rate. It severely affects the patients’ quality of life.AIMTo analyze the short-term effect and long-term prognosis of neuroendoscopic minimally invasive surgery for hypertensive intracerebral hemorrhage. METHODSFrom March 2018 to May 2020, 118 patients with hypertensive intracerebral hemorrhage were enrolled in our study and divided into a control group and observation group according to the surgical plan. The control group used a hard-channel minimally invasive puncture and drainage procedure. The observation group underwent minimally invasive neuroendoscopic surgery. The changes in the levels of serum P substances (SP), inflammatory factors [tumor necrosis factor-α, interleukin-6 (IL-6), IL-10], and the National Hospital Stroke Scale (NIHSS) and Barthel index scores were recorded. Surgery related indicators and prognosis were compared between the two groups.RESULTSThe operation time (105.26 ± 28.35) of the observation group was min longer than that of the control group, and the volume of intraoperative bleeding was 45.36 ± 10.17 mL more than that of the control group. The hematoma clearance rates were 88.58% ± 4.69% and 94.47% ± 4.02% higher than those of the control group at 48 h and 72 h, respectively. Good prognosis rate (86.44%) was higher in the observation group than in the control group, and complication rate (5.08%) was not significantly different from that of the control group (P > 0.05).The SP level and Barthel index score of the two groups increased (P < 0.05) and the inflammatory factors and NIHSS score decreased (P < 0.05). The cytokine levels, NIHSS score, and Barthel index score were better in the observation group than in the control group (P < 0.05).CONCLUSIONNeuroendoscopic minimally invasive surgery is more complicated than hard channel minimally invasive puncture drainage in the treatment of hypertensive intracerebral hemorrhage; however, hematoma clearance is more thorough, and the short-term effect and long-term prognosis are better than hard channel minimally invasive puncture drainage.     

高血压脑出血7天以上发生脑疝者的微创手术治疗

高血压脑出血发病率有逐年增高的趋势,发病年龄亦逐渐减小。出血量较小患者采取内科保守治疗,在治疗过程中,部分患者迅速发生再出血而被迫接受外科手术;一小部分患者在保守治疗7d甚至14d时逐渐出现意识障碍,甚至发生脑疝。我科自2002年以来共开展脑出血微创手术1 000余例,其中内科保守治疗7d以上发生脑疝后采取微创手术者8例,均取得良好治疗效果,现报告如下。     

微创手术对高血压基底节脑出血患者颅内感染风险及神经功能恢复的影响

目的 研究微创手术对高血压基底节脑出血患者颅内感染风险及神经功能恢复的影响.方法 选取2015年1月至2020年12月本院收治的56例高血压基底节脑出血患者作为研究对象,根据治疗方法的不同将其分为对照组与观察组,每组28例.对照组给予经颞叶皮质造瘘血肿清除术,观察组给予经侧裂-岛叶入路显微手术.比较两组的围术期相关指标...     

基底节区高血压脑出血术后脑梗死的防治

目的探讨基底节区高血压脑出血术后继发脑梗死的发病机制、预防和治疗措施。方法回顾性分析23例基底节区高血压脑出血术后继发脑梗死患者的临床资料。结果23例患者出院时按格拉斯哥预后评分（GOS）评定疗效：死亡4例（17．4％），植物生存3例（13．1％），重残6例（26．1％），中残5例（21．7％），恢复良好5例（21．7％）。结论基底节区高血压脑出血术后继发脑梗死是一种或多种因素相互作用所致，除注意术中微创操作外，还应重视围手术期的处理。对大面积脑梗死，必要时可行去大骨瓣减压加颞肌贴敷术治疗。     

小骨窗显微术治疗高血压基底节区脑出血的时机选择及对患者预后的影响

Objective To explore the timing selection of small-bone-window craniotomy microsurgery for cerebral hemorrhage on hypertensive basal ganglia and its effect on treatment emergent symptom scale (TESS) of patients. Methods A retrospective analysis was performed in 80 patients with cerebral hemorrhage on hypertensive basal ganglia, who received small- bone- window craniotomy microsurgery from January 2015 to June 2017 and divided into groups according to the different opportune moment of operation. The early operation was performed 6-48 hours after the occurrence of cerebral hemorrhage in control group, and ultra-early operation was performed within 6 hours after the occurrence of cerebral hemorrhage in observation group ( n = 40, each ) . Barthel activities of daily living index score ( Barthel index ) , clinical neurological deficit of stroke patients [ China Stroke Scale (CSS) ] , National Institutes of Health Stroke Scale (NIHSS) and TESS score were compared between two groups,and the patients were followed up for 6 months to observe the situation of rebleeding, rehospitalization and postoperative complications. Results One month after operation, the scores of Barthel index, CSS, NIHSS and TESS in observation group were significantly higher than those in control group ( P < 0. 05, P < 0. 01 ) ,however, there were no statistical differences in them at six months after operation ( P > 0. 05 ) . After postoperative six months, the total scores were significantly higher than those of the first month after operation in two groups ( P < 0. 01 ) . There were no significant differences in the rates of rebleeding and readmission between two groups ( P > 0. 05 ). The incidence of complications in observation group was significantly lower than that in control group (5. 00% vs 20. 00% ,д- = 4. 114,P = 0. 000 ). Conclusions In the treatment of cerebral hemorrhage on hypertensive basal ganglia, the timing selection of small bone window microsurgery has a certain effect on the prognosis of patients. The risk of complications after ultra-early operation is relatively low, and early operation has a little advantage in controlling rebleeding, so the best choice should be made according to the actual situation of patients. © The Author(s) 2020.     

神经内镜微创术与微创钻孔引流术治疗高血压 脑出血的临床效果与安全性分析*

目的对比分析神经内镜微创手术与微创钻孔引流术治疗高血压脑出血的临床效果与安全性。方法收集2017年1月-2017年12月该院神经外科收治的90例高血压脑出血患者的病历资料,进行回顾性分析。根据手术方式不同分为A组(47例,行神经内镜微创手术)和B组(43例,行微创钻孔引流手术),比较两组患者的手术时间、术中出血量、血肿清除率、住院时间、术后并发症发生情况及预后情况。结果 B组手术时间和术中出血量明显少于A组,A组血肿清除率(92.84±4.73)%明显高于B组(87.52±5.39)%,差异具有统计学意义(P 0.05)。两组术后住院时间、再出血发生率、并发症发生率和死亡率比较,差异均无统计学意义(P0.05)。术后3个月与术前比较,两组的美国国立卫生研究院脑卒中评分量表(NIHSS)均明显降低,日常生活活动评分(ADL)均明显升高,两组比较,差异均无统计学意义(P0.05)。A组和B组术后6个月预后良好率分别为93.62%和83.72%,组间比较差异无统计学意义(P0.05)。结论神经内镜微创术可提高血肿清除效果,微创钻孔引流术可缩短手术时间,减少术中出血量,两者均安全、可靠,且预后较好。     

神经内镜下微创手术对高血压基底节区脑出血患者术后神经功能恢复的影响

目的 探讨神经内镜下微创手术治疗高血压基底节区脑出血的效果.方法 选择2018年8月至2019年8月住院治疗的112例高血压基底节区脑出血患者为研究对象,按随机抽签法将其分为对照组和观察组,每组56例.对照组行小骨窗显微术,观察组行神经内镜下微创手术.比较两组的治疗效果.结果 观察组的手术时间、术中出血量、皮层切口、住...     

Prognostic value of intracranial pressure monitoring for the management of hypertensive intracerebral hemorrhage following minimally invasive surgery

BACKGROUND:The incidence of hypertensive intracerebral hemorrhage(HICH)has been increasing during the recent years in low-and middle-income countries.With high mortality and morbidity rates,it brings huge burden to the families.It lacks evidence regarding the application of intracranial pressure(ICP)monitoring in HICH.In the current study,the authors aimed to evaluate whether ICP monitoring could make any difference on the prognosis of HICH patients after minimally invasive surgery.METHODS:A retrospective review of 116 HICH patients admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine,between 2014 and 2016,was performed.The effects of ICP monitoring on 6-month mortality and favorable outcomes were evaluated by univariate and logistic regression analysis.RESULTS:ICP monitors were inserted into 50 patients.Patients with ICP monitoring had a significantly better outcome(P<0.05).The average in-hospital duration in patients with ICP monitoring was shorter than that in the patients without ICP monitoring(16.68 days vs.20.47 days,P<0.05).Mortality rates between ICP monitoring and no ICP monitoring did not differ significantly(16.0%vs.15.1%,P=0.901).On univariate analysis,age,Glasgow Coma Scale(GCS)on admission and presence of ICP monitor were independent predictors of 6-month favorable outcomes.CONCLUSION:ICP monitoring is associated with a better 6-month functional outcome compared with no ICP monitoring.Future study is still needed to confirm our results and elucidate which subgroup of HICH patients will benefit most from the minimally invasive surgical intervention and ICP monitoring.