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高血压脑出血微创穿刺清除治疗体会【关键词】高血压脑出血；微创穿刺清除术；治疗体会doi：103969/jissn1004-7484（x）201309297文章编号：1004-7484（2013）-09-5104-02我院自2010年至今共收治经微创穿刺治疗的高血压脑出血患者128例，其中行微创穿刺治疗75例，现就其不同的手术时机、治疗特点，再出血的防治，血肿破入脑室的治疗，谈点体会。
1资料与方法11一般资料本组75例，其中男性42例，女性33例，年龄45-78岁，平均60岁，均有高血压病史，最长24年，多数患者服药不规则或血压控制不良，起病突然，出血部位：基底节区53例，丘脑及皮层下出血22例。
合并破入脑室12例，出血后意识状态分级：ⅰ级12例，ⅱ级17例，ⅲ级30例，ⅳ级16例。
合并脑疝10例。
多田氏公式计算血肿量20-90ml，发病至手术时间6小时内35例，6-24小时33例，超过24小时的8例。
12治疗方法均采用yl—ⅰ型一次性颅内血肿穿刺针行血肿穿刺，生化酶技术溶解，多用尿激酶1-2万u不等，采用单针或多针穿刺，血肿大部分或基本清除后拔针，脑室出血采用脑室引流管引流，配合腰穿或腰大池引流，术后给予止血、预防感染、脱水、降颅压、控制血压、营养神经、预防并发症等治疗。
2结果术后动态复查ct，血肿基本清除时间为：3天24例，5天27例，7天12例，5例超过一周达10天左右，随访6-12月，依据adl分级评定疗效，ⅰ级8例，ⅱ级15例，ⅲ级24例，ⅳ级8例，ⅴ级3例，死亡12例，死亡原因为再出血，脑疝，肺部感染，糖尿病及肝、肾功能不全等合并症及并发症。
3讨论31手术时机高血压脑出血所致神经功能损害其机制一方面是由于血肿占位效应引起的机械性损伤，另一方面是血肿神经毒性物质引起的脑组织继发性损害，包括继发性缺血，再灌流与自由基链锁反应，凝血酶及其血肿成份的分解与吸收，炎性反应及其补体引起的免疫反应等致脑水肿，细胞凋亡等有关[1]，国内郭富强[1]张新庆[2]等研究认为，脑出血后血肿周围脑组织6小时内有轻微损伤，6小时以后逐渐加剧，24-48小时达高峰，因此，早期行血肿清除，防止或减轻血肿周围脑组织的继发性损害，减轻患者神经功能损害，降低致残率，本组6小时左右手术30例，有10例发生再出血，死亡4例，1例昏迷加深放弃治疗，12-24小时手术33例，1例发生再出血，死亡2例，我们认为，12-24小时手术再出血发生率相对更低，手术较适宜，但对危重及脑疝形成等病情危重者，应积极手术抢救。
微创穿刺引流治疗高血压脑出血的效果评价邓朝来【摘要】目的：比较高血压脑出血微创穿刺引流术与内科保守治疗高血压脑出血的疗效差异及安全性。
方法选取行微创穿刺引流术的高血压脑出血（ HICH）患者37例为微创治疗组，同期入院行内科保守治疗的HICH患者31例为内科治疗组，比较两组近期疗效、并发症发生情况，采用日常生活活动能力量表（ ADL）评价生存质量。
结果微创治疗组与内科治疗组总有效率分别为75．68％和51．61％，微创治疗组显著高于内科组（ P＜0．05），死亡率分别为5．41％和9．68％，两者比较差异无统计学意义。
微创治疗组预后良好率（83．78％）明显高于内科治疗组（61．29％），脑疝及消化道出血发生率明显低于内科治疗组（ P＜0．05或P＜0．01）。
结论微创穿刺引流术能有效提高HICH患者的生存质量，疗效显著，且安全性高，值得临床推广应用。
%Objectives To compare the difference of clinical efficacy and safety of minimally invasive puncture drainage and conventional treatment of Department of Internal Medicinein the treatment of patients with hypertensive intra -cerebral hemorrhage ( HICH) .Methods A total of 37 HICH patients undergoing minimally invasive puncture drainage served as minimally invasive group while another 31 HICH undergoing conventional treatment as conventional treatment group .Short-term efficacy and complica-tions were compared between two groups , and scale of activity of daily living ( ADL) was usedto evaluate the quality of life ( QOL) . Results The total effective rates of minimally invasive group and conventional treatment group were75.68%and 51.61%, respec-tively, and there was significance difference(P<0.05), whereas the mortality rates were 5.41% and 9.68% respectively, and there was no significant difference .Good prognostic rate of minimally invasive group was 83.78%, markedly higher than the 61.29%in conventional treatment group , and rates of cerebral hernia and gastrointestinal hemorrhage were prominently lower in minimally invasive group than in conventional treatment group (P<0.05 orP<0.01).Conclusions Minimally invasive puncture drainage can effectively improve the QOL of HICH patients with favorable clinical efficacy and high safety , thus deserving to be widely used in clinic .【期刊名称】《中国老年保健医学》【年(卷),期】2015(000)005【总页数】3页(P45-46,47)【关键词】高血压脑出血;微创穿刺引流术【作者】邓朝来【作者单位】云南省文山市人民医院神经外科 663000【正文语种】中文近年来，高血压患者数量呈全球性增加，若不加以控制，在今后20年里将增加60%［1］。
微创颅内血肿清除术治疗高血压脑出血的临床效果分析目的对微创颅内血肿清除术治疗高血压脑出血的临床效果进行分析。
方法方便选取该院2013年5月—2015年5月间收治的84例高血压脑出血患者作为临床研究对象，随机分为观察组42例及对照组42例。
观察组采取微创颅内血肿清除术进行治疗，对照组采取开颅血肿清除术进行治疗，对比两组患者治疗效果。
结果观察组总有效率为97.62%，对照组总有效率为88.10%，观察组总有效率要高于对照组（P＜0.05）；观察组手术时间要短于对照组，且术中出血量要少于对照组（P＜0.05）；观察组共出现并发症3例（7.14%），对照组共出现并发症9例（21.43%），观察组并发症发生率要低于对照组（P＜0.05）。
结论微创颅内血肿清除术治疗高血压脑出血效果较好，出血量少，术后并发症少。
[Abstract] Objective To investigate the effect ofthe minimally invasive intracranial hematoma removal technique in treatment ofhypertensive cerebral hemorrhage.Methods Convenient selection 84 cases of hypertensive cerebral hemorrhage patients in our hospital were selected from May 2013 to May 2015 and randomly divided into 42 cases of observational group and 42 cases of control group. The observational group was treated with minimally invasive intracranial hematoma removal technique，and the control group was treated with hematoma by craniotomy，compared the curative effect of the two groups of patients. Results The total effective rate of observational group was 97.62%，the total effective rate of control group was 88.10%，the total effective rate of observational group was higher than that of control group （P＜0.05）；The operation time of the observational group was shorter than that of the control group，and the amount of bleeding during the operation was less than that of the control group （P＜0.05）；There were 3 cases of complications in the observational group，and 9cases of complications in the control group，the complication rate of observational group was lower than the control group （P 0.05），具有可比性。
