治疗高血压脑出血三种术式疗效和预后研究

目的探讨血肿穿刺引流辅助开颅血肿清除术、小骨窗开颅血肿清除术和大骨瓣开颅血肿清除术治疗高血压脑出血的疗效及预后,为治疗提供依据。方法选择重庆医科大学附属第一医院2004年1月—2010年12月180例高血压脑出血患者分别采用3种术式进行治疗,比较术后1个月患者的病死率及6个月后日常生活能力(ADL)。结果 3组患者术后1个月的病死率比较,差异无统计学意义(χ2=0.288,P=0.866)。3组术后6个月ADL分级比较,差异有统计学意义(χ2=11.212,P=0.004);血肿穿刺引流组术后6个月ADL分级分别与小骨窗开颅组、大骨瓣开颅组比较,差异均有统计学意义(χ2=6.541,P=0.011;χ2=9.701,P=0.002);而小骨窗开颅组与大骨瓣开颅组比较,差异无统计学意义(χ2=0.333,P=0.564)。结论对于出血量过大,昏迷程度深,出现脑疝前期或已经出现脑疝甚至晚期的患者,临床上应当首先考虑采用血肿穿刺引流辅助开颅血肿清除术。

Research on the Effect and Prognosis of Three Different Operation Methods for Hypertensive Intracerebral Hemorrhage

Objective To investigate the curative effect and prognosis of three different operation methods(puncture drainage as well as craniotomy evacuation of hematoma,small bone window craniotomy and big craniotomy with bone flap)for hypertensive intracerebral hemorrhage in order to provide evidence for treatment.Methods 180 patients with hypertensive intracerebral hemorrhage treated by three different operation methods between January 2004 and December 2010 at the first affiliated hospital of Chongqing Medical University were given three different operation methods.One-month postoperative fatality and six-month ADL were compared among the three groups.Results There was no statistically significant difference in one-month postoperative fatality among the three groups(χ2=0.288,P=0.866).However,there was statistically significant difference in six-month ADL classification among the three groups(χ2=11.212,P=0.004);The six-month ADL of brain hematoma puncture drainage group had statistically significant difference compared with small bone window craniotomy group and big craniotomy with bone flap group(χ2=6.541,P=0.011;χ2=9.701,P=0.002).But there was no statistically significant difference in six-month ADL between small bone window craniotomy group and big craniotomy with bone flap group(χ2=0.333,P=0.564).Conclusion Puncture drainage as well as craniotomy evacuation of hematoma is a preferred method in clinical treatment for patient with excessive hemorrhage,deep coma or various stage herniations.