高血压脑出血外科治疗随机对照研究

[1]陈军 李爱民 吴海滨 颜士卫 陈覃 司宪平 施辉 王富元 江伟 刘希光 孙维晔

【摘要】 目的 对比高血压脑出血的大骨瓣开颅、CT 引导血肿微创穿刺引流和微骨窗入路三种手术方法，分析手术疗效。方法 我院手术治疗493 例出血性脑卒中病例，完成3 个月随访，采用随机对照研究方法比较不同手术方式疗效。结果 493 例中大骨瓣组128 例，微骨窗组82 例，微创穿刺引流组283 例。1 个月累计病死率19. 3%，3 个月累计病死率21. 1%。术前Glasgow 昏迷评分（GCS）≤8 分的病人，术后3 个月病死率是GCS≥8 分的3. 5 倍；术后有并发症者，术后3 个月病死率是无并发症者的4. 4 倍；丘脑出血术后3 个月病死率是皮层出血病人的2. 4 倍。3 个月的病死率大骨瓣组（24. 2%）高于微骨窗组（17. 1%）和微创穿刺引流组（20. 5%）。三组间术后并发症，大骨瓣组（29. 9%）与微创穿刺引流组（24. 8%）差异具有统计学意义（P = 0. 015）。结论 微骨窗入路及CT 引导微创穿刺引流术组治疗高血压脑出血的手术病死率与致残率，以及预后的改善情况，优于大骨瓣开颅组。

【关键词】 颅内出血，高血压性； 微创神经外科； 颅骨切开术； CT 引导微创穿刺引流术； 微骨窗入路

The single-blind study of efficacy of three different approaches in treatment of hypertensive intracerebral hemorrhage CHEN Jun, LI Aimin，WU Haibin, et al. Departtment of Neurosurgery, Lian Yun Gang Hospital , Xuzhou Medical College, Lianyungang 222002，China

【Abstract】Objective To compare the efficacy and indications of the 3 approaches：conventional open craniotomy（COC），computed- tomography guided aspiration（ CTGA），and key-hole approach（KHA）in neurosurgical management for hypertensive intracerebral hemorrhage（HICH）. Methods The clinical data of HICH 493 patients，aged 14-75，operated on within 24 hours after stroke，with a Glasgow coma score ≥5，hospitalized in our hospital，were collected and underwent single-blind study. Results Among the 493 patients 128 underwent COC，283 unerwent CTGA，and 82 were operated on via KHA. The overall mortality rates within one and three months after operation were 19. 3% and 21. 1% respectively. The mortality rate within 3 months after operation（M3m）of the patient with a GCS≤8 was 3. 5 times as much as the M3m of the patients with a GCS≥8. The M3m of the atients with complications was 4. 4 times as much as that of the patients without complications. The M3m of the patients with hemorrhage in thalamus was 2. 4 times as much as that of the patients with cortical hemorrhage.The M3m of the COC group was 24. 2%，higher than those of the KHA group（17. 1%）and CTGA group（20，5%）. The postoperative complication rate of the COC group was 29. 9%，significantly higher than that of the CTGA group（ 24. 8%，P = 0. 015 ）. There were no significant differences in postoperative complication rate between the COC and KHA groups and between the CTGA and KHA groups（ both P > 0. 05）. Conclusion KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.

【Key words 】 Intracranial hemorrhage，hypertensive； Minimally invasive neurosurgery；Craniotomy； Computed tomography guided aspiration； Key-hole approach