摘要
目的探讨长期血液透析患者并发颅内出血的治疗策略。方法回顾性分析41例慢性肾衰竭长期血液透析并发颅内出血患者的临床资料,分析患者的出血部位、出血量、治疗方案与预后的关系。结果内科保守治疗33例,其中好转20例,死亡13例。治疗好转患者出血量均<40 mL,死亡患者中有2例脑干出血,其他出血量均>40 mL。外科手术8例,血肿量均>40 mL,其中开颅血肿清除术5例,血肿量均>60 mL,术后4例死亡,1例存活;钻孔引流术3例,2例存活,1例死亡。结论出血量<40 mL的幕上脑出血,少量的小脑甚至脑干出血,保守治疗能有相对较好预后。脑出血40 mL以上、进行性脑出血,或脑出血破入脑室造成梗阻脑积水,理论上应积极手术治疗,但由于止血困难、术后再出血及严重的脑水肿仍可造成患者死亡,手术治疗要慎重。
Objective To explore treatment strategies for patients with chronic hemodialysis complicated with intracranial hemorrhage.Methods Retrospectively analyzing the clinical data of 41 cases with hemodialysis complicated with intracranial hemorrhage. Analyzing the relationship between the prognosis and the site,volume of bleeding and treatment options. Results 33 cases used conservative treatment method. 20 cases were improved,and 13 cases died. The amount of bleeding was less than 40 mL in the improved patients. Among dead cases,2 dead cases had brain stem hemorrhage,and others bleeding volume were greater than 40 mL. Hematoma volume of 8 patients underwent surgical operation was more than 40 mL,with the craniotomy evacuation of hematoma in 5 cases. Hematoma volume was more than60 mL. 4 patients died. 1 case survived. In 3 cases with trepanation and drainage,2 cases survived,and 1 cases died. Conclusion Medical treatment can have a relatively good prognosis in the patients of supratentorial intracranial bleeding amount less than 40 mL,small amount of the cerebellum and even brainstem hemorrhage. Patients with the bleeding volume above 40 mL,or obstructive hydrocephalus caused by intraventricular hemorrhage should get operation theoretically; but because of the difficulty of hemostasis,postoperative hemorrhage and severe cerebral edema causing death of patients,the operation treatment must be done carefully.
出处
《黑龙江医学》
2014年第9期1005-1006,共2页
Heilongjiang Medical Journal
关键词
血液透析
颅内出血
治疗
Hemodialysis
Intracranial hemorrhage
Treatment
