CT引导下微创清创术与高压氧联合治疗脑出血的价值研究

目的探讨CT引导下微创清除术治疗高血压脑出血（HICH）的价值，以及联合高压氧（HBO）治疗的意义。方法以内科保守治疗的125例HICH患者作为对照组，将CT引导下微创清除术治疗的223例HICH患者按有无进行HBO治疗，随机分为2个观察组，对两组的疗效进行对比分析；对微创术后行HBO治疗前、后患者的脑血流动力学变化进行观察。结果CT引导下微创清除术治疗HICH的总有效率迭90、14％，观察组与对照组的疗效率比较有统计学意义（P〈0.001）；超早期清除血肿疗效高，差异有统计学意义（X^2=29．89，P〈0．0001）；6d内血肿基本清除的患者预后较好，差异有统计学意义（X2=10.00，P=0.04）；首次血肿清除率与疗效问无统计学意义（P=0.788）。微创清除术患者行HBO治疗前、后脑血流动力学参数比较有统计学意义（P〈0.01）。结论CT引导下微创清除术治疗HICH是一种操作简单、定位准确、疗效显著的首选方法，具有推广使用价值；微创术联合HBO治疗可以提高患者的治愈率以及生存质量。

Value of treatment with micro-wound cleaning combined with hyperbaric oxygen guided by CT on cerbral hemorrhage

Objective To study the value of treatment with micro-wound cleaning guided by CT on hypertensive intracere- bral hemorrhage （ HICH ） and the significance of combination with hyperbaric oxygen （ HBO ）. Methods 125 cases of patients with HICH treated with medical expectant treatment （ control group ） and 223 cases of patients with HICH treated with micro- wound cleaning guided by CT （ treatment group ） were observed. The treatment group was then divided into two groups, with HBO treatment and without HBO treatment. Furthermore, the changes of hemodynamics before and after the treatment with HBO were also observed. Results The total effective rate of treatment with micro-wound cleaning guided by CT on HICH was 90.14%. There was significant difference compared to the control group （ P 〈 0. 001 ） ; the curative effect of earlier period cleaning hematoma was better（ X^2 = 29.89 ,P 〈 0. 0001 ） ;the prognosis of patients whose hematoma was cleaned within 6 days was better（ X^2 = 10.00 ,P = 0. 04 ）. There was no difference between the rate of first time clearance of hematoma and the curative effect（P = 0. 788）. The hemodynamics parameters before and after treatment with HBO were different （P 〈 0. 01） . Conclusion The treatment of micro-wound cleaning guided by CT on HICH is a firstly selected method with the advantages of simple operation,accurate localization and remarkable curative effect. It is worth spreading. The combination with HBO can increase the recovery rate and survival quality.