定向微创血肿引流术对脑出血患者脑供血的影响

目的：观察脑出血患者行微创血肿抽吸引流术前后TCD参数的变化,研究该手术对脑灌注的影响。方法：动态监测66例发病24小时内入院的脑出血患者的血压,并于入院时及入院后第2、4、6、12天行TCD监测,其中36例入院24小时内接受血肿抽吸引流术（手术组）,30例行内科常规治疗（对照组）。结果：两组患者治疗过程中血压逐渐下降,手术组血压下降幅度较对照组大,第12天收缩压差异显著（P〈0.01）。双侧大脑中动脉（MCA）流速呈先降后升,双侧动脉指数（PI）值呈先升后降。手术组第6天MCA流速即开始升高,PI值降低,且在第12天两组间差异显著（P〈0.05）;对照组MCA流速于第6天内呈下降改变,而第12天开始升高,PI值改变与之相反。手术组平均住院日较对照组短（P〈0.01）。结论：微创血肿引流术可显著性改善脑出血患者的脑灌注。

Ornenting to the Influence that the Drain - operation of the Slightly - ungured Blood Plump has on the Blood- supply to the Brain of the Patients with Cerebral Hemorrhage

Objective:To observe the changes of TCD parameters presurgery and postsurgery in the patients with acute intracerebral hemorrhage(ICH),and try to evaluate the effects of surgery on cerebral perfusion.Methods:The blood pressure(BP)of 66 patients with intracerebral hemorrhage was monitored within the first 24 hours after its onset,and they were monitored by TCD in the 2nd,4th,6th,and 12th day after onset,among them.36 patients were treated by medication and stereotactic computed tomographic(CT)guided drain and aspiration within the first 24 hours,30 patients were only treated by medication(the control group).Results:BP of ICH patients gradually reduced during the period of therapy,while middle cerebral artery b1ood flow velocity(MFV)decreased in the early days and then increased;PI increased first and then decreased,but there was a remarkable difference in the two groups.In the fourteenth day,comparing the TCD parameters of the two groups(P<0.05),in the surgery group PI decreased while MFV began to increase in the 6th day,and there was remarkable difference between the two groups at 12th day(P<0.05).In the control group of decreased in the first week,and then increased in the second week.PI changed in the oposite way.BP decreased greatly in the surgery group.There was significant difference in BP and the TCD parameters in the fourteenth day(P<0.01).Conclusion:Therapy by stereotactic computed tomographie(CT)guided drain and aspiration could improve the cerebral perfusion in acute intracerebral hemorrhage.