高血压脑出血微创术后再出血的临床治疗

目的通过高血压性脑出血微创手术后患者再次出血的治疗,分析原因及对策。方法选取2003年9月～2011年3月采用微创钻孔穿刺引流和小骨窗开颅血肿清除术治疗高血压脑出血,术后再次出血的48例患者作为研究对象,并给予再次手术清理血肿,观察疗效分析原因。结果 48例再出血患者经过治疗,37例止血效果良好,7例效果一般,4例效果较差。术后随访半年,按日常生活活动能力分级评估:1级5例,2级14例,3级11例,4级10例,5级3例。2例3月后死于MODS。结论围手术期基础疾病治疗,术中和术后血压控制是减少和治疗微创术后再出血的关键。

Clinical analysis on the cause of rehaemorrhagia caused by hypertensive cerebral hemorrhage by the treatment of minimally invasive and open operation

Objective To discuss the etiological factor for patients with hypertensive cerebral hemorrhage with minimally invasive operation and open operation on postoperative bleeding again through the analysis of multiple factors.Methods We reviewed the cases of September 2003 to March 2011 with minimally invasive trepanation and drainage and craniotomy with small bone window craniotomy hematoma removal in two different operation methods in the treatment of rebleeding after operation for hypertensive intracerebral hemorrhage of 48 cases,retrospective patient medical history,including diabetes,high blood lipids;intraoperative difficulties with hemostasis,hematoma irregular morphology,postoperative high diastolic blood pressure,blood pressure control instability and other related case analysis of minimally invasive surgery and again after hemorrhage clinical related factors.Results In 48 cases of bleeding patients after treatment,37 cases with mild hemostatic effect,7 cases,4 cases of the poor.After half a year of follow-up,in activities of daily living ability grading assessment:1 of 5 cases,2 of 14 cases,3 of 11 cases,10 cases of Grade 4,Grade 5 in 3 patients.In March,2 cases died of MODS.Conclusion Peri operation period basis for disease treatment,intraoperative and postoperative blood pressure control is the reduction and minimally invasive treatment of postoperative rebleeding of key.