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目的探讨高血压脑出血早期微创手术方法的选择原则及疗效。方法分析三年中收治的160例患者,其中男94例,女66例,年龄28～84岁,所有患者入院前均有高血压病史,手术均在发病后6～12小时内进行。根据患者的CT结果,并结合患者意识状况,采取不同的微创手术方法。结果160例患者中95例行血肿钻孔引流术,49例行双侧脑室外引流术,10例患者行小骨窗开颅血肿清除术,6例行一侧脑室外引流术。术后生存126例,死亡34例。生存患者随访3个月～3年,ADLⅠ级33例,Ⅱ级31例,Ⅲ级45例,Ⅳ级34例,Ⅴ级18例。手术优良率为68.13%(109/160),死亡率为21.25%(34/160)。结论高血压脑出血微创手术方法的选择主要取决于出血部位和出血量,同时患者术前的意识和瞳孔演变也是重要的参考因素。微创手术能够降低患者的死亡率,提高患者的生活质量。
Objective To investigate the principle of selection and curative effect of minimally invasive surgery for hypertensive intracerebral hemorrhage in the early stage. Methods A total of 160 patients admitted in three years were enrolled. Among them, 94 were males and 66 were females, ranging in age from 28 to 84 years. All patients had a history of hypertension before admission. The surgery was performed within 6 to 12 hours after onset. According to the patient’s CT results, combined with patient awareness, to take a different approach to minimally invasive surgery. Results Of the 160 patients, 95 were treated with hematoma drainage and drainage, 49 were treated with bilateral ventricular drainage, 10 were operated with small craniotomy and 6 were treated with ventricular extradural drainage. Postoperative survival of 126 cases, 34 patients died. Survival patients were followed up for 3 months to 3 years, ADL Ⅰ grade 33 cases, Ⅱ grade 31 cases, Ⅲ grade 45 cases, Ⅳ grade 34 cases, Ⅴ 18 cases. The excellent and good rate of operation was 68.13% (109/160) and the mortality rate was 21.25% (34/160). Conclusion The choice of minimally invasive surgery for hypertensive intracerebral hemorrhage mainly depends on the bleeding site and the amount of bleeding. At the same time, preoperative awareness and pupillary evolvement are also important reference factors. Minimally invasive surgery can reduce patient mortality and improve patient quality of life.