摘要
目的探讨不同时间点经额部入路锥颅置管血肿抽吸液化引流术治疗高血压基底节脑出血常见并发症及死亡原因。方法经额部入路锥颅置管血肿抽吸液化引流术治疗高血压基底节脑出血患者109例,按手术治疗时间分为6h以内组(A组)24例,6～12h组(B组)36例,12～24h组(C组)20例,24h以上组(D组)29例。各组出血量均为50～80mL,均采用额部入路进行穿刺,同时使用有可调节钻入深度的限位器的钻头,钻穿颅骨,置入硅胶管抽吸部分血肿后,再引流。于手术后30d分别进行神经功能评分、术后脑疝、再出血、脑积液等并发症及病死率观察比较。结果治疗后30d各组之间病死率、再出血及脑疝发生率A组明显高于其他各组(P<0.05);30d比较神经功能评分(改良爱丁堡+斯堪的那维亚评分标准)A、B组均优于C、D组,而并发症(再出血、脑疝)及病死率比较A组明显高于其他各组,差异有统计学意义(P<0.05)。结论手术时机过早增加再出血及死亡风险,而过晚手术对患者神经功能恢复不利,6～12h手术最有利于病情恢复及减少风险。
Objective To study the death causation and complicating disease of the hypertensive cerebral hemorrhage treated by haematoma fluidify drainage operation through the entrance route of forehead in different time point. Methods One hundred and nine cases of hypertensive cerebral hemorrhage in the basal ganglion which treated by haematoma fluidify drainage operation though the entrance of forehead were divided into four groups according to the time point, the patients who aecepl the operation in 6 hours as group A. 6 - 12 hours as group B,12 -24 hours as group C, longer than 24 hours as group D. The bleeding quantities are both 50-80 ml. in each group, both adopted the forehead route puncture. At the same time , we use the aiguille with restrict position implement that can adjust the depth, bore the skull, place silica gel tube and pump portion of haematoma, and then drainage. We observe the neural-functional grade, hernia of brain; relapsing cerebral hemorrhage, cerebral effusion and death rate after the operation for 30 days. Results After operation for 30 days, the death rate and relapsing cerebral hemorrhage, hernia of brain rate were obviously higher in the group A than those in the other groups （P〈0.05）, to compare the neural-functional grade after operation, group A and B are better than group C and D, the complicating disease （hernia of brain, relapsing cerebral hemorrhage） and death rate in group A are significantly higher than those in other groups, and there is statistic significance （P〈0.05）. Conclusion Too early operation will increase the risk of relapse of cerebral hemorrhage and death rate, too late will affect the resume of neural function, taking operation in 6- 12 hours will benefit the resume of the illness and avoid the risks.
关键词
脑出血
高血压
穿刺术
Cerehral hemorrhage
Hypertension
Punctures
