不同骨瓣开颅治疗高血压脑出血的疗效比较

目的:探讨大骨瓣开颅和小骨窗开颅治疗高血压脑出血的适应证和疗效。方法:采用大骨瓣开颅(大骨瓣开颅组)和小骨窗开颅(小骨窗开颅组)2种术式治疗高血压脑出血168例,同时按格拉斯哥昏迷评分和出血量分为不同亚组,对2种术式的疗效进行对比分析。结果:小骨窗开颅组较大骨瓣开颅组手术时间和住院时间均明显缩短(P<0.01),格拉斯哥预后评分升高(P<0.01),2组再出血率差异无统计学意义(P>0.05),出血量大(>50 ml)的患者采用大骨瓣开颅病死率低于采用小骨窗开颅(P<0.05)。结论:不同骨瓣开颅治疗高血压脑出血各有优缺点,结合格拉斯哥昏迷评分和出血量来选择合适的术式,能提高治疗的成功率和生存质量。

Effect comparison of different bone flap craniotomy in the treatment of hypertensive cerebral hemorrhage

Objective:To explore the indications and effects of large bone flap craniotomy and small bone window craniotomy in the treatment of hypertensive cerebral hemorrhage. Methods:One hundred and sixty-eight patients with hypertensive cerebral hemorrhage were treated with large bone flap craniotomy and small bone window craniotomy. The patients were divided into two groups according to the Glascow Coma Scale and amount of bleeding. The curative effects between two groups were compared. Results:The time of operation and hospitalization and Glascow Outcome Scale score in patients treated with the small bone flap craniotomy were significantly shorter and higher than those in patients treated with large bone flap craniotomy,respectively(P <0. 01). The difference of rebleeding rate between two groups was not statistically significant(P > 0. 05). The large bone flap craniotomy combined with decompressive craniectomy for treating the patients with haemorrhage amount more than 50 ml could significantly reduce the mortality rate(P<0. 05). Conclusions:Different bone flap craniotomy in treating hypertensive cerebral hemorrhage has different advantages and disadvantages. Selecting suitable operation according to the amount of bleeding and GCS score can improve the success rate of treatment and quality of life.