高血压小脑出血的手术治疗（附31例报告）

[目的]探讨手术治疗高血压性小脑出血的时机、方法及疗效.[方法]经侧脑室穿刺置引流管持续引流后颅窝开颅小脑血肿清除术治疗高血压小脑出血31例.[结果]本组病例术前重度神志障碍29例（GCS评分3～8分）,中度2例（9～12分）,无轻度病例.术后24 h CT复查血肿,血肿清除80%～90%.术后24 h,5例意识清醒;1周后重度神志障碍6例（3～8分）,中度10例（9～12分）轻度9例（13～15分）;存活病例清醒平均时间13.5天.再出血1例,术后死亡4例均为院内死亡,其中再发出血死亡1例,脑干衰竭死亡3例.随访6月,生存27例,根据GOS评分：5分7例,4分16例,3分4例.ADL分级：Ⅰ级7例,Ⅱ级8例,Ⅲ级10例,Ⅳ2例,Ⅴ级0例.[结论]手术治疗高血压小脑出血患者,能迅速彻底清除血肿,降低病死率,有利于神经功能恢复.

Surgical Treatment of Hypertensive Cerebellar Hemorrhage(a report of 31 cases)

[Objective] To explore the timing, method and effect of surgical treatment of hypertensive cerebellar hemorrhage. [Methods]Thirty one patients with hypertensive cerebellar hemorrhage underwent persistent external ventricular drainage and removal of cerebellar hematoma by open surgery simultaneously, [Resuits] Of all patients, 29 patients were severe disturbed consciousness（3-8 scores of GCS）, and 2 patients were middle（9-12 scores of GCS）, and no one was mild. Postoperative 24h reexamination of CT scans showed 80-90% of hematoma were removed. Five patients regained consciousness 24h after operation. One week later, there were 6 patients with severe disturbed consciousness（3-8 scores of GCS）, 10 middle（9-12 scores of GCS） and 9 mild（13-15 scores of GCS）. The average conscious time was 13.5 days. One patient occurred rebleeding. Four patients died in the hospital after operation due to rebleeding in 1 patients and brainstem failure in 3 patients. After 6-month follow up, 27 patients were still alive. According to GOS score, 7 patients were 5 scores, and 16 patients were 4 scores, and 4 patients were 3 scores. According to ADL, there were 7 patients in grade I , 8 in grade Ⅱ , 10 in grade Ⅲ , 2 in grade IV and no one in grade V. [Conclusion] Surgical treatment of hypertensive cerebellar hemorrhage can clear cerebellar hematoma promptly, decrease mortality and improve recovery of neurological function.