颅内血管畸形破裂致颅内血肿的急诊诊治分析(附132例报告)

目的探讨132例颅内血管畸形破裂致颅内血肿急诊治疗方法。方法对9年多所收治的132例颅内血管畸形患者的急诊治疗及注意事项进行分析。其中血管畸形全切除 颅内血肿清除术89例、血管畸形部分切除 颅内血肿清除术3例、单纯血肿清除术5例，脑室外引流术11例，保守治疗24例。治疗注意事项：术中皮层切口选择距血肿最近处，尽量减少皮层破坏，仔细寻找畸形血管团，力争畸形团全切，止血彻底；脑室外引流应保持通畅，可给予尿激酶冲洗，禁负压引流；保守治疗应密切观察病情变化，有脑疝形成可能及时手术。结果97例开颅手术89例血管畸形团全部切除，3例畸形团部分切除，死亡5例；脑室外引流11例，死亡7例；保守治疗组无死亡。结论及时正确处理可减少脑血管畸形破裂出血的病死率和致残率。

Acute management of intracanial hematoma on cerebrovascular malformation（report of 132 cases）

Objective To investigate acute management of intracanial hematoma on cerebrovascular malformation in 132 patients Methods To analyze the acute therapy and attention in 132 cases of cerebrovascular malformation who have been treated for 9 years These management include excision of vascular malformation and evacuation of hematomas (89 cases),partial excision of vascular malformation and evacuation of hematomas (3 cases),evacuation of hematomas (5 cases),drainage of ventriculocentesis (11 cases),conservative therapy (24 cases) Approach was selected the nearest from cerebral cortex to hematomas The demage of cortex wound be decreased as much as possible Looked carefully for the malformation and try to remove it totally,while stanch the bleeding thoroughly Drainage of ventriculocentesis should be kept fluently and washed by urokinase Negative pressure drainage is forbidden To obsive carefully the change of disease during conservative treatment and opreat timely herniation arises Results 97 cases of vascular malfomation were removed totally,3 cases were removed partially and 5 cases died in opreation group No mortality was discorered in cases of conservative therapy Conclusion Cerebrovascular malformatino rupture has higher mortality and morbidity and timely therapy is effective to decrease it