高血压脑出血外科治疗96例分析

马清涛

doi：10.3969/j.issn.1007-614x.2014.2.5

摘 要 目的：探讨外科手术治疗高血压脑出血的最佳治疗方案。方法：回顾分析高血压脑出血患者96例，根据出血量的多少及昏迷程度采取去骨瓣减压血肿清除术；小骨窗开颅血肿清除术；LY-1型颅内血肿粉碎穿刺针引流术；脑室外引流等手术方式。结果：96例患者按照生活能力作为疗效评价指标。完全恢复日常生活12例；部分恢复但能独立生活29例；扶拐行走34例；卧位，生活不能自理，但意识清楚11例；植物生存状态7例；死亡3例。结论：选择合适的手术方式，早期手术能降低病死率，提高高血压脑出血的手术疗效。

关键词 高血压 脑出血 外科治疗

Analysis of 96 cases of hypertensive cerebral hemorrhage with surgery treatment

Ma Qingtao

Surgical Department of Luoning County Maternal and Child Health Hospital Luoyang City，Henan Province，471700

Abstract Objective：To explore the best treatment of surgical operation in the treatment of hypertensive cerebral hemorrhage.Methods：96 cases of hypertensive cerebral hemorrhage were retrospectively analyzed.We take the operation in different ways according to the amount of hemorrhage and the severity of coma，such as decompressive craniectomy and evacuation of hematoma，small bone window craniotomy evacuation of hematoma，LY-1 type of intracranial hematoma smash puncture drainage，external ventricular drainage and so on.Methods：We evaluated the efficacy of 96 patients with living ability.12 cases were complete recovery of daily life.29 cases were partial recovery but can live independently.34 patients walked with crutches.11 cases had the need for bed and their life can not take care of themselves.7 cases were vegetative state.3 cases died.Conclusion：Select the suitable operation and early operation can decrease the mortality rate and improve the operation effect of hypertensive cerebral hemorrhage.

Key words Hypertension；Cerebral hemorrhage；Surgical treatment

高血压脑出血是自发性非创伤性脑出血病中的一种，发病率高、死亡率高以及致残率高。治疗上一般是运用外科手术对患者脑内的血肿进行清除，从而使患者的颅内压降低，并且解除脑疝[1]。何时对患者进行手术，并且为患者选择哪种手术方式，都要因人而异，这是提高手术成功率、提高患者生存质量的关键[2]。2008年7月-2013年6月收治高血压脑出血患者96例，根据出血量多少及GLS评分等级，采用不同方式治疗，取得了较好效果，现报告如下。

资料与方法

96例患者中，男64例，女32例，年龄37～83岁，平均59.8岁，有高血压病史89例，病史5～45年，所有患者入院时血压均高于正常水平，在130/95mmHg～260/130mmHg，平均175.3/109mmHg。

意识障碍程度评分（Glasgow）：根据出血后意识状态临床分5级[3]。Ⅲ级51例，Ⅳ级37例，Ⅴ级8例，单侧瞳孔散大89例，双侧瞳孔散大7例，临床表现术前偏瘫68例，失语17例，脑病形成64例。

出血量及血肿部位：96例患者均行CT检查，确立出血量及出血部位，发现基底节区出血48例，破入脑室及脑室系统16例，脑叶出血21例，单纯脑室出血并铸型5例，小脑出血6例。……