肖宏伟

脑出血的手术和超早期止血治疗研究

肖宏伟

【摘要】目的 评价脑出血超早期止血治疗手术疗效。方法 采用大骨瓣开颅手术治疗38例纳入A组、采用小骨窗开颅手术治疗54例纳入B组、采用血肿穿刺抽吸术52例纳入C组，对比30日内死亡例，术后30日GOS评分、卒中量表（SSS）评分、Barthel日常生活能力（ADL）评分。结果 A组死亡5例、B组死亡7例、C组死亡8例，差异无统计学意义（P＞0.05）；B组、C组SSS评分高于A组，C组ADL评分高于A组、B组，差异具有统计学意义（P＜0.05）。结论 血肿穿刺抽吸术有助于减轻神经功能损伤，增强存活患者生活能力。

【关键词】脑出血；手术；超早期；止血

作者单位：150050 哈尔滨市道外区太平人民医院

Study on Cerebral Hemorrhage Operation and Ultra Early Hemostatic Therapy

XIAO Hongwei, Harbin Daowai District, Taiping People's Hospital, Harbin 150050, China

[Abstract]Objective To evaluate curative effect of ultra early hemostatic therapy for intracerebral hemorrhage surgery. Methods The big bone flap craniotomy treatment of 38 cases were included in group A, the small bone window craniotomy treatment of 54 cases were included in group B, 52 cases into group C and contrast within 30 days of death cases, postoperative 30. Glasgow Outcome Scale (GOS), stroke volume table scale score (SSS), barthel activities of daily living (ADL) score with hematoma aspiration. Results In group A died 5 cases died in the 7 cases in group B and group C death in 8 cases, the difference was not statistically significant (P>0.05). B group and C group SSS score is higher than that of group A, C group ADL score is higher than that of group A and group B, the difference is statistically significant (P<0.05). Conclusion Hematoma aspiration can help alleviate neurological damage, enhance the survival ability of life.

[Key words]Cerebral hemorrhage, Surgery, Ultra early, Hemostatic

及时止血，抑制脑血肿形成、扩大，减轻压迫性神经损伤，是脑出血重要治疗原则。脑出血尚无特效治疗方法，近年来微创手术技术迅速发展，超早期手术止血治疗逐渐受到医师与患者推崇，临床证实出血72 h内患者手术与非手术患者预后无显著性差异，提示早期手术是可行的[1]。脑出血超早期手术治疗主要包括大骨瓣开颅手术、血肿穿刺抽吸引流术、脑室外引流血肿溶解术等，关于哪种手术综合获益更好，尚未有明确共识。

1　资料及方法

1.1 一般资料

选取2011年2月～2014年7月，神经外科共收治144例患者作为研究对象，其中男73例、女71例，年龄47～74岁、平均（58.3±10.3）岁。左侧基底节66例、右侧78例。合并高血压104例，高血压病程3～24年、平均（14.2±5.0）年。近3个月内服用抗凝药物48例。合并糖尿病23例、冠心病15例。出血量50～90 ml、平均（77.5±7.5）ml。消化道出血13例。纳入标准：（1）经CT、MRI诊断为脑出血；（2）发病至手术时间6 h内，GCS评分7～11分；（……