高血压脑出血180例的外科治疗探讨

目的探讨高血压脑出血的规范化外科治疗。方法回顾性分析2008年1月至2011年1月3年间重庆医科大学附属第一医院神经外科手术治疗180例高血压脑出血患者的临床资料。结果其中采用开颅血肿清除及去骨瓣减压术63例,小骨窗开颅血肿清除术48例,脑室穿刺外引流术42例,立体定向血肿穿刺碎吸引流术27例。所采用的术式与患者术前意识评分(GCS)、出血部位及出血量有显著相关性(P<0.05)。超早期(<7h)手术后再出血率为9.7%,早期(7～24h)和延迟期(>24h)手术未见再出血病例。术后追踪随访6个月,预后良好率达60.5%。结论采用个体化的治疗原则,采用恰当的术式及选择正确的手术时机能明显提高治愈率,降低病死率及致残率。

Discussion of 180 patients with hypertensive intracerebral hemorrhage by surgical treatment

Objective To explore the standardized surgical therapy for patients with hypertensive intracerebral hemorrhage.Methods We retrospectively reviewed 180 cases of hypertensive intracerebral hemorrhage from January 2008 to January 2011.Results Of 180 cases,63 cases were operated by hematoma removal plus decompressive craniectomy,48 cases by craniotomy with small skull flap,42 cases by external ventricular drainage,27 cases by CT guided stereotaxic hematoma aspiration.Surgical approaches were correlated with surgical preoperative GCS,the site of bleeding and amount of bleeding(P<0.05).Postoperative bleeding of ultra-early(<7 h) surgery was 9.7%,early(7-24 h) and delayed(>24 h) surgery cases showed no bleeding again.Curative effects were followed up 6 months and analyzed by the scores of ADL,the better prognosis was 60.5%.Conclusion According to the principle of individualized treatment,with appropriate operation modes and choosing the proper timing of surgery can significantly improve the cure rate,reduce mortality and morbidity.