外科治疗高血压脑出血合并脑疝的临床分析

目的以高血压脑出血为典型病例，讨论用小骨窗开颅显微镜下钻孔引流术与改良去骨瓣减压术在治疗脑疝中的应用。方法选取我院2007年1月__2011年1月外科治疗的高血压脑出血合并脑疝患者102例，随机分为两组，各51例。研究组采用微创脑血肿穿刺引流术。对照组采用改良去骨瓣减压术。比较两组患者术后12个月格拉斯哥结果评分（GOS评分）。结果两组患者死亡率及重、轻度残疾率比较，差异无统计学意义（P〉0．05）；研究组理想治疗率为50．91％，对照组为29．41％，两组比较差异有统计学意义（P〈0．05）。术后24h，研究组残留血肿〉20m／或发生再次出血的患者13例，对照组为7例，差异无统计学意义（P〉0．05）。结论对于出血量〈60ml，脑疝症状较轻的患者采用小骨窗开颅显微镜下钻孔引流术治疗效果与改良去骨瓣减压术无异，且术后恢复更好。

Clinical Analysis of Surgical Treatment of Hypertensive Cerebral Hemorrhage with Cerebral Hernia

Objective To discuss the methods of small bone hole drilling drainage and modified decompressive crani- ectomy to treat hypertension cerebral hemorrhage cerebral hernia merger. Methods Choosed 102 hypertension cerebral hemor- rhage combined cerebral hernia merger patients from Jan. 2007 to Jan. 2011 to divide into study group and controlled group with 51 cases in each other. The study group were treated with modified decompressive craniectomy, and controlled group were trea- ted with invasive brain hematoma puncture drainage minimally. Compared the GOS scores of these two groups followed - up 12 months. Results The rate of recovery in study group was 50. 91%, higher than 29.41% in controlled group （ P 〈 0. 05）. Conclusion If the hemorrhage amount is less than 60ml, we should choose small bone hole drilling drainage better than modi- fied decompressive craniectomy to treat hypertension cerebral hemorrhage combined cerebral hernia merger.