高血压脑出血外科治疗63例临床分析
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摘要
目的
探讨影响高血压脑出血外科手术疗效的各种相关因素。
方法
回顾性分析二年来在本科行手术治疗的高血压脑出血病例共63例，采用小骨瓣开颅血肿清除术，对血肿破入脑室的采用侧脑室外引流术或加用血肿清除术。探讨血肿位置、血肿量、术前GCS评分和术后并发症如术后再出血、上消化道出血、肺部感染等因素对本病死亡率的影响。
结果
63例高血压脑出血病例经手术治疗后治愈或好转的41例，死亡22例(占34.9％)。脑叶血肿、基底节外侧区血肿和基底节内侧区血肿的死亡率分别为16.7％、24.6％和77.0％。血肿量为＜30ml、30～50ml、50～80ml、＞80ml组的死亡率分别为16.7％、46.2％、33.3％、17.6％。GCS评分在13～15分组的死亡率为13.3％，9～12分组的死亡率为28.3％，3～8分组的死亡率为47.1％。术前病情分级为Ⅰ～Ⅴ级的死亡率分别为0％、18.8％、30.0％、29.6％、83.3％。术前病情和术后并发症的发生和预后密切相关，经logistic回归多因素分析影
浙江大学硕士学位论文
响术后死亡率的主要因素，按其影响的大小顺序为：术前“S评分、
术后再出血、肺部感染、血肿量。
结 论
影响高血压脑出血疾病预后的因素众多，其中术前GCS评分、术
后再出血、肺部感染、血肿量和预后密切相关。
Objective:
To explore the surgical therapeutic effect of hypertensive intracerebral hemorrhage and evaluate the related factors to the surgical therapy . Methods:
63 cases of hypertensive intracerebral hemorrhage treated surgical therapy from the year 2001 to 2002 in our department were analyzed retrospectively. Hematoma evacuations were applied with minor bone flap craniotomy opening, while external ventriclar drainge administrated for the patients with hemorrhage rupture into the ventricles The location and volume of hematoma, pre-operation GCS score and post-operation complications like
postoperative rebleeding, hemorrhage of upper digestive tract and lung infection.were evaluated to determine the effects of these factors on the surgical mortality rate.
Results:
Among these 63 cases of hypertensive intracerebral hemorrhage receiving surgical therapy, 41 cases of them improved while 22 cases died (34.9%). The mortality rates for patients with hematoma located in lobar, lateral basalganglian region or medial basalganglian region were 16.7%, 24.6% 77.0% respectively. The mortality rate for for the subgroups with hematoma volume at less than 30ml,30-50ml,50-80ml and more than 8oml were16.7%, 46.2%,33.3%, 17.6% respectively. Our results also indicated that the mortality rates for the subgroups with GCS scores at 13-15, 9-12, and 3-8 were 13.3%, 28.3% and 47.1% respectively. Based on the pre-operation condition, subgroups with I-V grades showed their mortality at 0%, 18.8%, 30.0%, 29.6% and 83.3%. Moreover, it was also indicated that there more close relationships between the pre-operation condition and the post-operation complications. With the Logistic analysis of multiple factors, the four main factors had been showed to have greater impacts on
prognosis of hypertensive intracerebral hemorrhage in the significant sequence: pre-operation GCS score, post-operation rebleeding, lung infection and hemotoma volume (p<0.05).
Conclusion:
Among various factors affecting the prognosis of patients with hypertensive intracerebral hemorrhage, pre-operation GCS score, post-operation rebleeding, lung infection and hemotoma volume are the most important ones which are closely related with the mortality (P<0.05).
探讨影响高血压脑出血外科手术疗效的各种相关因素。
方法
回顾性分析二年来在本科行手术治疗的高血压脑出血病例共63例，采用小骨瓣开颅血肿清除术，对血肿破入脑室的采用侧脑室外引流术或加用血肿清除术。探讨血肿位置、血肿量、术前GCS评分和术后并发症如术后再出血、上消化道出血、肺部感染等因素对本病死亡率的影响。
结果
63例高血压脑出血病例经手术治疗后治愈或好转的41例，死亡22例(占34.9％)。脑叶血肿、基底节外侧区血肿和基底节内侧区血肿的死亡率分别为16.7％、24.6％和77.0％。血肿量为＜30ml、30～50ml、50～80ml、＞80ml组的死亡率分别为16.7％、46.2％、33.3％、17.6％。GCS评分在13～15分组的死亡率为13.3％，9～12分组的死亡率为28.3％，3～8分组的死亡率为47.1％。术前病情分级为Ⅰ～Ⅴ级的死亡率分别为0％、18.8％、30.0％、29.6％、83.3％。术前病情和术后并发症的发生和预后密切相关，经logistic回归多因素分析影
浙江大学硕士学位论文
响术后死亡率的主要因素，按其影响的大小顺序为：术前“S评分、
术后再出血、肺部感染、血肿量。
结 论
影响高血压脑出血疾病预后的因素众多，其中术前GCS评分、术
后再出血、肺部感染、血肿量和预后密切相关。
Objective:
To explore the surgical therapeutic effect of hypertensive intracerebral hemorrhage and evaluate the related factors to the surgical therapy . Methods:
63 cases of hypertensive intracerebral hemorrhage treated surgical therapy from the year 2001 to 2002 in our department were analyzed retrospectively. Hematoma evacuations were applied with minor bone flap craniotomy opening, while external ventriclar drainge administrated for the patients with hemorrhage rupture into the ventricles The location and volume of hematoma, pre-operation GCS score and post-operation complications like
postoperative rebleeding, hemorrhage of upper digestive tract and lung infection.were evaluated to determine the effects of these factors on the surgical mortality rate.
Results:
Among these 63 cases of hypertensive intracerebral hemorrhage receiving surgical therapy, 41 cases of them improved while 22 cases died (34.9%). The mortality rates for patients with hematoma located in lobar, lateral basalganglian region or medial basalganglian region were 16.7%, 24.6% 77.0% respectively. The mortality rate for for the subgroups with hematoma volume at less than 30ml,30-50ml,50-80ml and more than 8oml were16.7%, 46.2%,33.3%, 17.6% respectively. Our results also indicated that the mortality rates for the subgroups with GCS scores at 13-15, 9-12, and 3-8 were 13.3%, 28.3% and 47.1% respectively. Based on the pre-operation condition, subgroups with I-V grades showed their mortality at 0%, 18.8%, 30.0%, 29.6% and 83.3%. Moreover, it was also indicated that there more close relationships between the pre-operation condition and the post-operation complications. With the Logistic analysis of multiple factors, the four main factors had been showed to have greater impacts on
prognosis of hypertensive intracerebral hemorrhage in the significant sequence: pre-operation GCS score, post-operation rebleeding, lung infection and hemotoma volume (p<0.05).
Conclusion:
Among various factors affecting the prognosis of patients with hypertensive intracerebral hemorrhage, pre-operation GCS score, post-operation rebleeding, lung infection and hemotoma volume are the most important ones which are closely related with the mortality (P<0.05).
引文
1．王忠诚，赵雅度．神经外科学．武汉：湖北科学技术出版社，1998．686-690．
2. Deinsberger W, Vogel J, Fuchs C, et al. Fibrinolusis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurol Res, 1999,21: 517-523.
3. Wagner KR, Xi G, Hua Y, et al. Ultra-ealy clot aspiration after lysis with tissue plasminogen activator in aporcine model intracerebral hemorrhage : edema reduction and blood-brain barrier protection. J Neurosurg, 1999,90: 491-498.
4. Kanaya H,Kuroda K.Development in neurosurgical approach to hypertensive intracerebral hemorrhage in Japan. In: intracrerebral Hematoma,ed.by Kaufman HK,New York,Raven Press, 1992:97
5. Kanaya H, Kuroda K. Development in neurosurgical approaches to hypetensive intracerebral hemorrhage in Japan. In: Kaufman HH, ed. Intracerebral hematomas. New York: Raven Press, 1992.197-209.
6. Fayad PB, Awad IA. Surgery for intracerebral hemorrhage Neurology, 1998,51 (suppl 3): s69-s73.
7 Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentouial intracerebral hemorrhage: a randomized feasibility study.
Stroke, 1999,30: 1833-1839.
8. Morgenstem LB, Frankowski RF, Shedden P, et al. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology, 1998,51:1359-1363.
9. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma : a randomized study. J Neurosurg, 1989,70:530-535.
10. Batjer HH , Reisch JS , Allen BC , et al . Failure of surgery to improve outcome in hypertensive intracerebral putaminal hemorrhage. A prospective randomized trial. Arch Neurol, 1990,47: 1103-1106.
11. Prasad K, Browan G, Srivastava A, et al .surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trails. Acta Neurol Scand, 1997,95: 103-110.
2. Deinsberger W, Vogel J, Fuchs C, et al. Fibrinolusis and aspiration of experimental intracerebral hematoma reduces the volume of ischemic brain in rats. Neurol Res, 1999,21: 517-523.
3. Wagner KR, Xi G, Hua Y, et al. Ultra-ealy clot aspiration after lysis with tissue plasminogen activator in aporcine model intracerebral hemorrhage : edema reduction and blood-brain barrier protection. J Neurosurg, 1999,90: 491-498.
4. Kanaya H,Kuroda K.Development in neurosurgical approach to hypertensive intracerebral hemorrhage in Japan. In: intracrerebral Hematoma,ed.by Kaufman HK,New York,Raven Press, 1992:97
5. Kanaya H, Kuroda K. Development in neurosurgical approaches to hypetensive intracerebral hemorrhage in Japan. In: Kaufman HH, ed. Intracerebral hematomas. New York: Raven Press, 1992.197-209.
6. Fayad PB, Awad IA. Surgery for intracerebral hemorrhage Neurology, 1998,51 (suppl 3): s69-s73.
7 Zuccarello M, Brott T, Derex L, et al. Early surgical treatment for supratentouial intracerebral hemorrhage: a randomized feasibility study.
Stroke, 1999,30: 1833-1839.
8. Morgenstem LB, Frankowski RF, Shedden P, et al. Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial. Neurology, 1998,51:1359-1363.
9. Auer LM, Deinsberger W, Niederkorn K, et al. Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma : a randomized study. J Neurosurg, 1989,70:530-535.
10. Batjer HH , Reisch JS , Allen BC , et al . Failure of surgery to improve outcome in hypertensive intracerebral putaminal hemorrhage. A prospective randomized trial. Arch Neurol, 1990,47: 1103-1106.
11. Prasad K, Browan G, Srivastava A, et al .surgery in primary supratentorial intracerebral hematoma: a meta-analysis of randomized trails. Acta Neurol Scand, 1997,95: 103-110.