微创穿刺术加尿激酶血肿清除治疗高血压脑出血的临床研究
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摘要
在我国,高血压和脑出血的发病率、致残及致死率均较高,目前还缺乏明确的有效的治疗方法。大多数学者的共同看法是相对出血量较大的或有脑疝倾向的神经内科治疗短期病情继续恶化的幕上出血以及>10mL以上的小脑出血要积极手术治疗。随着科技的发展,手术方法多种多样,各有其优缺点；但目前更多的学者更喜欢使用对脑组织损伤较小的微侵袭治疗,并且也取得一定的效果。高血压脑出血的治疗现在仍然有很多没有明确的问题,如外科治疗是的优势、手术时机的选择等。
研究目的：本研究的目的是为了深入阐释微创颅内血肿清除术在治疗高血压脑出血过程当中所起到的优势作用。
研究方法：主要是采取了比较分析的方法,即选择保守组当中的44个病例实施内科综合治疗；然后选择开颅组的44个病例在保守组治疗的基础之上进行开骨瓣或者是骨窗,并清除血肿；最终再选择微创组的43个病例在保守组治疗的基础之上实施微创颅内血肿清除术,再获得相关数据信息之后,将三组治疗的各个因素进行t与X2检验对比分析,分析内容主要包括了有效率、死亡率以及治疗前后神经功能缺损评分等。
研究结果：通过对比分析发现,在治疗有效率方面,微创组最高,开颅组次之,保守组最低；在死亡率方面,保守组最高,开颅组次之,而微创组最低。而且微创组在与开颅组以及保守组进行t与X2检验对比分析之后发现,都有显著性的差异(P<0.05)；微创组在治疗结束之后的第一天就明显降低恶神经功能缺损评分,而开颅组以及保守组则都是在治疗之后的第14天才明显降低恶神经功能缺损评分,在进行t与X2检验对比分析之后发,都有显著性的差异(P<0.05)。
结果讨论：在高血压脑出血治疗当中,相比较于传统的保守治疗以及开颅治疗而言,微创颅内血肿清除术能够有效的提高有效率、降低死亡率,并极大的加快了神经功能恢复,有着明显的治疗优势。
Now hypertensive cerebra hemorrhage has high rate of incidence, disability and mortality in China, which lacks the effective therapy. Early operation may be effective. The majority opinion is that the operation is necessary in patients with biggish hemorrhage volume, trend of brain hernia, hemorrhage above cerebella curtain with continuous deteriorative condition after medical treatment and cerebella hemorrhage above 10ml needing operation. With the development of technology, there are many operating method, which have own advantages and disadvantages. Now more and more neurosurgeon prefer to micro-invasive operation, which achieve some efficacy. There are still many unclear issue in the treatment of hypertensive cerebral hemorrhage about surgical therapy in its advantages, selection of surgical opportunity.
Objective:To evaluate the advantages of minimally invasive evacuation of hematoma for treatment of hypertensive intracerebral hemorrhage.
Methods:44 cases in group-A received conservative medical treatment,44 cases in group-B received craniotomy based on medical treatment and 43 cases in group-C received minimally invasive evacuation based on medical treatment. The effective rate, mortality and neurological deficit scale of three groups were compared, and statistical data were processed with chi-square test.
Results:The effective rate and mortality in group-C were 93.02% and 2.33%, respectively, which was significantly different from that in group A (40.91% and 22.73%, respectively, P<0.05) and group B (59.09% and 11.36%, respectively, P< 0.05).
Conclusion:The minimally invasive evacuation of hematoma can improve the effective rate, decrease the mortality and promote the recovery of neurological function in the treatment of hypertensive intracerebral hemorrhage.
研究目的：本研究的目的是为了深入阐释微创颅内血肿清除术在治疗高血压脑出血过程当中所起到的优势作用。
研究方法：主要是采取了比较分析的方法,即选择保守组当中的44个病例实施内科综合治疗；然后选择开颅组的44个病例在保守组治疗的基础之上进行开骨瓣或者是骨窗,并清除血肿；最终再选择微创组的43个病例在保守组治疗的基础之上实施微创颅内血肿清除术,再获得相关数据信息之后,将三组治疗的各个因素进行t与X2检验对比分析,分析内容主要包括了有效率、死亡率以及治疗前后神经功能缺损评分等。
研究结果：通过对比分析发现,在治疗有效率方面,微创组最高,开颅组次之,保守组最低；在死亡率方面,保守组最高,开颅组次之,而微创组最低。而且微创组在与开颅组以及保守组进行t与X2检验对比分析之后发现,都有显著性的差异(P<0.05)；微创组在治疗结束之后的第一天就明显降低恶神经功能缺损评分,而开颅组以及保守组则都是在治疗之后的第14天才明显降低恶神经功能缺损评分,在进行t与X2检验对比分析之后发,都有显著性的差异(P<0.05)。
结果讨论：在高血压脑出血治疗当中,相比较于传统的保守治疗以及开颅治疗而言,微创颅内血肿清除术能够有效的提高有效率、降低死亡率,并极大的加快了神经功能恢复,有着明显的治疗优势。
Now hypertensive cerebra hemorrhage has high rate of incidence, disability and mortality in China, which lacks the effective therapy. Early operation may be effective. The majority opinion is that the operation is necessary in patients with biggish hemorrhage volume, trend of brain hernia, hemorrhage above cerebella curtain with continuous deteriorative condition after medical treatment and cerebella hemorrhage above 10ml needing operation. With the development of technology, there are many operating method, which have own advantages and disadvantages. Now more and more neurosurgeon prefer to micro-invasive operation, which achieve some efficacy. There are still many unclear issue in the treatment of hypertensive cerebral hemorrhage about surgical therapy in its advantages, selection of surgical opportunity.
Objective:To evaluate the advantages of minimally invasive evacuation of hematoma for treatment of hypertensive intracerebral hemorrhage.
Methods:44 cases in group-A received conservative medical treatment,44 cases in group-B received craniotomy based on medical treatment and 43 cases in group-C received minimally invasive evacuation based on medical treatment. The effective rate, mortality and neurological deficit scale of three groups were compared, and statistical data were processed with chi-square test.
Results:The effective rate and mortality in group-C were 93.02% and 2.33%, respectively, which was significantly different from that in group A (40.91% and 22.73%, respectively, P<0.05) and group B (59.09% and 11.36%, respectively, P< 0.05).
Conclusion:The minimally invasive evacuation of hematoma can improve the effective rate, decrease the mortality and promote the recovery of neurological function in the treatment of hypertensive intracerebral hemorrhage.
引文
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【3】徐力,吴春辉,邓洁瑜等。大骨瓣开颅术对重症高血压脑出血的临床分析。海南医学,2005,8：112-114
【4】王德江,王硕等。高血压脑出血外科治疗近期预后多因素分析。中华医学杂志,2005,85：3118-3122
[5]Prasad K, Rrowan G, Sirvastava A, et al. Surgery in primary supratentorial intracerebral hematoma:A meta-analysis of randomized trails. Acta Neurol Scand,2007,95:103-110
[6]Kirollos RW, Tyagi AK, Ross SA, et al. Management of spontaneous cerebellarhematomas:aprospective treatment protocol. Neurosurgery, 2001,49:1378-1386
【7】李云辉,林中平,黄建龙等。超早期锁孔血肿清除术治疗高血压基底节出血24例。中国危重病急救医学,2005,；：66
【8】张刚中,吴江等,经侧裂入路显微手术处理基底节出血27例。实用神经疾病杂志,2005,5：99
【9】曾群,赵静涛,陈勇等。CT定位小骨窗开颅血肿清除术治疗高血压脑出血。中国现代手术学杂志,2000,1：72-73
[10]Backlunded ED, Holstvh VH. Controled subtotal evacuation of intracerebral hematomas by stereotactic technique. Surg Neurol,1978,9:99-101
【11】杜建新,凌峰等。小骨窗开颅术和钻孔引流术治疗高血压脑出血疗效的对比研究。中国脑血管病杂志,2004.1：10-12
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