陈春峰　曹胜武

作者单位：1.江苏省苏州市吴江区江苏盛泽医院　神经外科　215228　2.江苏省人民医院　神经外科　210029

超早期显微手术治疗高血压基底节区脑出血56例临床分析

陈春峰1曹胜武2

作者单位：1.江苏省苏州市吴江区江苏盛泽医院神经外科2152282.江苏省人民医院神经外科210029

【摘要】目的评价超早期小骨窗显微手术治疗高血压基底节区脑出血的临床价值。方法回顾性分析56例(观察组)行超早期(7小时内)小骨窗显微手术治疗高血压基底节区脑出血患者的临床资料，以同期35例行早期显微外科手术患者为对照组。比较两组患者的血肿清除情况、术后再出血与术后1月格拉斯哥预后评分(GOS)情况。结果观察组血肿清除率90%以上者52例(92.9%)，血肿清除率60%～89%者4例(7.1%)，对照组血肿清除率90%以上26例(74.3%)，血肿清除率60%～89%者9例(25.7%)，组间差异有统计学意义(P<0.05)。观察组术后第2天再出血率(8.9%)低于对照组(25.7%)(P<0.05)。观察组术后1月患者的痊愈率(53.6%)高于对照组(31.4%)，两组比较差异有统计学意义(P<0.05)。结论超早期小骨窗显微手术治疗高血压基底节区脑出血患者血肿清除率高，可预防术后再出血发生情况，促进术后神经功能恢复，是一种较好的手术方式。

【关键词】超早期显微手术高血压病基底节脑出血

doi:10.3969/j.issn.1672-4860.2015.06.017

【Abstract】ObjectivesTo evaluate the clinical value of small bone-flap minimally invasive surgery for hypertensive basal ganglia hemorrhage (HBGH) at ultra-early stage. MethodsClinical data of 56 patients with HBGH undergoing small bone-flap minimally invasive surgery at ultra-early stage (within 7 hours) were retrospectively analyzed and designed as observation group. Additionally, 35 patients with HBGH at the same period undergoing the same surgery at early stage were collected as control group. The condition of hematoma clearance, postoperative hemorrhage and Glasgow Outcome Score (GOS) score after 1 month were compared. There were 52 cases (92.9%) of hematoma clearance rate>90%and 4 cases (7.1%) of hematoma clearance rate between 60%～89%in observation group, and 26 cases (74.3%) of hematoma clearance rate>90%and 9 cases (25.7%) of hematoma clearance rate between 60%～89%in control group, and there were statistical difference between two groups (P<0.05). The rate of postoperative hemorrhage was 8.9%, lower than control group (25.7%) (P<0.05). The curative rate after 1 month of surgery was higher in observation group (53.6%) than in control group (31.4%) (P<0.05). ConclusionsSmall bone-flap minimally invasive surgery for HBGH at ultra-early stage is a better operational method for it has high hematoma clearance rate, can prevent postoperative hemorrhage and better recovery of neutological function.

收稿日期：2015-11-1

Clinical analysis of small bone-flap minimally invasive surgery for hypertensive basal ganglia hemorrhage at ultra-early stage: 56 cases(CHENChunfeng1,CAOShengwu2. 1.Departmentofneurosurgery,ShengzehospitalofWujiangdistrict,Suzhou215228; 2.Departmentofneurosurgery,Jiangsuprovincehospital,Nanjing210029,China.)

【Key words】Ultra-early stage, microsurgical operation, hypertension, basal ganglion hemorrhage

高血压基底节脑区出血是脑外科常见的危重急症，可导致高致死率、高致残率，早期救治基底节区脑出血可降低患者死亡率、减轻伤残率，改善患者预后。超早期(7小时内)小骨窗显微外科手术是发展较快的一种手术方式，目前已经成清除基底节区血肿的主要方式，该手术方法血肿清除率高、止血彻底。本研究回顾性分析了2011年2月~2013年12月间开展的56例超早期小骨窗显微手术治疗高血压基底节区脑出血患者的临床资料，以同期35例早期显微外科手术治疗患者为对照，比较超早期与早期显微外科手术治疗高血压脑基底节脑出血的疗效，现报告如下。