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目的:探讨和总结高血压性丘脑出血在CT引导下使用微创穿刺术的治疗方法,以提高患者的治疗效果。方法:收集2004-08-2012-08期间使用的微创穿刺血肿抽吸术治疗高血压性丘脑出血82例患者的临床资料和CT影像学检查资料,分析其临床治疗过程,进一步总结出微创穿刺技术在高血压性脑出血患者中的治疗经验。结果:本组病例中,患者以偏瘫(76例)、意识障碍(64例)、偏身感觉障碍(55例)、语言障碍(47例)、发热(42例)为主要症状。根据CT影像学表现分型:Ⅰa型12例,Ⅰb型例20例,Ⅱa型17例,Ⅱb型25例,Ⅲ型8例。结合CT计算出血量10ml≤V<30ml45例,V≥30ml37例。全部病例均在CT引导下行微创穿刺血肿抽吸术,其中死亡10例(12.2%),存活者术后三月内复查随访,经ADL(ActivityofDailyLiving)日常生活活动分级:Ⅰ级(恢复社会活动)12例(14.6%)、Ⅱ级(恢复家庭活动)21例(25.6%)、Ⅲ级(生活需照顾,辅助行走)30例(36.6%)、Ⅳ级(长期卧床)9例(11.0%)。结论:CT引导微创穿刺血肿抽吸术治疗高血压性丘脑出血微创、快速,临床具有明显的治疗效果。
Objective: To investigate and summarize the treatment of hypertensive thalamic hemorrhage using minimally invasive puncture under the guidance of CT, in order to improve the therapeutic effect of patients. METHODS: Clinical data and CT imaging data of 82 patients with hypertensive thalamic hemorrhage treated with minimally invasive invasive hematoma aspiration during the period of August 2004 to June 2012 were collected, their clinical course of treatment was analyzed, and minimally invasive Treatment experience of puncture technique in patients with hypertensive intracerebral hemorrhage. Results: The main symptoms of this group were hemiplegia (76 cases), disturbance of consciousness (64 cases), hemifacial sensation (55 cases), speech disorder (47 cases) and fever (42 cases). According to the manifestations of CT imaging, 12 cases were type Ⅰa, 20 cases were type Ⅰb, 17 cases were type Ⅱa, 25 cases were type Ⅱb and 8 cases were type Ⅲ. Combined with computed tomography, blood volume 10ml≤V <30ml45 cases, V≥30ml37 cases. All patients were guided by CT guided descending minimally invasive aspiration, including 10 deaths (12.2%). Survivors were followed up within 3 months after surgery. The activity of Daily Living (ADL) was graded as Grade I ) (N = 21), grade Ⅱ (restoring family activities) in 21 cases (25.6%), grade Ⅲ (36.6% in life requiring care and assisted walking) ). Conclusion: CT-guided minimally invasive puncture hematoma aspiration in the treatment of hypertensive thalamic hemorrhage minimally invasive, rapid, clinically significant therapeutic effect.