重症高血压脑出血手术方式选择及预后的临床研究

目的探讨高血压脑出血更合理更有效的手术方式。方法采用单盲研究方法,根据患者的神经功能状态、血肿量、血肿部位等选择穿刺血肿抽吸引流术、小骨窗开颅血肿清除显微手术、常规传统骨瓣开颅血肿清除手术。结果本组高血压脑出血手术治疗160例,3个月生存134例。ADL评级:Ⅰ级31例、Ⅱ级45例、Ⅲ级41例、Ⅳ级12例、Ⅴ级5例。疗效优于普遍报道。结论根据病情个体化选择重症高血压脑出血手术治疗方式能有效降低病死率和致残率,缩短康复时间。定向穿刺血肿抽吸引流术方法简单有效、创伤小、康复时间短、神经功能保留较好。血肿量较大合并脑疝患者行骨瓣开颅清除血肿及骨窗减压能有效挽救生命。显微镜下手术能减轻手术创伤、保护神经功能、减少再出血。

Clinical Research of Surgical Options and Prognosis about Severe Hypertensive Intracerebral Hemorrhage Patients

Objective To study the cerebral hemorrhage is more reasonable and more effective surgery.Methods Single-blind methodology,based on the patient＇s neurological status,hematoma volume,hematoma puncture site hematoma aspiration and other drainage options,a small bone window hematoma evacuation microsurgery,conventional traditional craniotomy hematoma removal operation.Results The surgical treatment of hypertensive intracerebral hemorrhage in 160 cases,134 cases of survival of 3 months.ADL rating：Ⅰ level in 31 cases,Ⅱ grade 45 cases,Ⅲ grade 41 cases,Ⅳ grade in 12 cases,Ⅴ level in 5 cases.Effective than universal coverage.Conclusion The individual selected according to the condition of severe surgical treatment of hypertensive intracerebral hemorrhage can reduce the mortality and morbidity,shorten recovery time.Directed Aspiration and drainage of hematoma puncture method is simple and effective,less invasive,recovery time is short,good nerve function preservation.Hematoma volume greater merger of hernia patients undergoing craniotomy hematoma removal and bone window decompression can effectively save lives.Microscopic surgery can reduce surgical trauma,protection of nerve function and reduce bleeding.