高血压脑出血的外科治疗体会

目的总结应用外科手术治疗高血压脑出血的体会,为临床治疗高血压脑出血提供参考。方法对湖南省娄底市中心医院2008年3月至2009年12月收治的58例高血压脑出血患者采用外科手术进行血肿清除。根据患者的意识障碍分级、出血量、血肿部位等手术指征分别采用微创开颅血肿清除术(26例)和去骨瓣减压血肿清除术(32例)进行治疗。结果采用微创开颅血肿清除术患者存活24例,术后生存率92、3%,采用去骨瓣减压血肿清除术患者存活29例,术后生存率90、6%,两组患者术后生存率比较,差异无统计学意义(P>0.05)。采用微创开颅血肿清除术患者术后发生并发症4例,发生率为15.38%,采用去骨瓣减压血肿清除术患者术后发生并发症3例,发生率为9.38%,两组患者术后并发症比较,差异有统计学意义(P<0.05)。结论微创开颅血肿清除术适用高血压脑出血发病早期、意识障碍分级Ⅰ～Ⅱ级的患者,去骨瓣减压血肿清除术适用于高血压脑出血发病中期、意识障碍分级Ⅲ～Ⅴ级的患者。结合患者的手术指征选择合适的手术治疗方案是取得良好治疗效果的关键。

Surgical Treatment of Hypertensive Cerebral Hemorrhage

Objective To summarize the surgical experience of treatment of hypertension stroke,stroke for clinical reference for the treatment of hypertension.Methods The hospital in March 2008～ December 2009 58 cases of hypertensive cerebral hemorrhage were treated by surgery for patients with hematoma.Graded according to the patient＇s consciousness,bleeding,hematoma and other parts of minimally invasive surgical indications were hematoma evacuation（26 cases） and decompress craniotomy hematoma（32 cases） for treatment.Results The minimally invasive hematoma evacuation of patients survived in 24 cases,92、3% survival rate,the use of decompress craniotomy in patients with hematoma survival in 29 cases,90、6% survival rate,postoperative survival rate the difference was not statistically significant（P0.05）.Minimally invasive hematoma evacuation in patients with postoperative complications in 4 cases,the rate was 15.38%,the use of decompress craniotomy in patients with postoperative hematoma complications in 3 cases,the rate was 9.38%,two groups of patients postoperative complications,the difference was statistically significant（P0.05）.Conclusion Minimally invasive hematoma evacuation for hypertensive cerebral hemorrhage early onset,disturbance of consciousness level grade Ⅰ～Ⅱ patients,decompress craniotomy for hematoma incidence of hypertension in stroke mid-grade Ⅲ～Ⅴ consciousness class of patients.Indications for surgery in patients with appropriate surgical treatment options is the key to achieve good treatment.