孙世航+刘波+谢才兰

【摘要】 目的：探讨高血压脑出血患者血肿物理状态的术前判断，血肿物理状态分型和手术方式选择。方法：高血压脑出血血肿物理状态分为液化为主型、混合型和血块为主型。103例高血压脑出血患者根据术前患者病史、服药史、DIC化验、CT等行血肿物理状态判断与术中所见对比。结果：根据手术前血肿物理状态判断选择相应的手术方法，液化和混合型血肿多选择微创手术引流血肿，而血块为主型多选择开颅清除血肿。液化为主型血肿术前判断漏误诊率2.1%，混合型血肿术前判断漏误诊率5.1%，血块为主型血肿术前判断漏误诊率50.0%。结论：提高高血压脑出血的血肿物理状态的准确判断率，利于选择相应的手术方式，减少手术损伤和二次手术次数、可改善患者的预后。

【关键词】 高血压脑出血； 物理状态； 分型

中图分类号 R743.34 文献标识码 B 文章编号 1674-6805（2016）26-0012-02

【Abstract】 Objective：To discuss the types of physical state of the hematology and operation mode in patients with hypertensive cerebral hemorrhage.Method：The physical state of the hematology in hypertensive cerebral hemorrhage was divided into mainly liquefied clot type，mainly blood clot type and mixed type.Corresponding surgical methods were used according to the type of physical state of the hematology before operation judged by preoperative patient history，medication history，DIC test，CT and other elements of the hematology.The types of physical state of the hematology before operation were compared with physical state of the hematology during operation in 103 cases with hypertensive cerebral hemorrhage.Result：The corresponding operation method was choosed according to the preoperative hematoma physical state judgment， more liquefied and hybrid hematoma were choosed minimally invasive surgical drainage of the hematoma，while type，blood clots was choosed more clear craniotomy hematoma.Liquefaction was given priority to type hematoma preoperative judge leakage misdiagnosis rate by about 2.1%，mixed hematoma preoperative judge leakage misdiagnosis rate by about 5.1%，Blood clots mainly type hematoma preoperative judge leakage misdiagnosis rate by about 50.0%.Conclusion：Improved typing accuracy of the physical state of hematology in hypertensive cerebral hemorrhage is beneficial to choose correspondingsurgical method，reduce surgical injury and secondary surgery，and improve the prognosis of patients.

【Key words】 Hypertensive cerebral hemorrhage； Physical state； Type

高血压脑出血手术方式选择与手术时机、出血部位、出血量、病情轻重等因素有关[1]。另外血肿物理状态与手术方式的选择也密切相关，血肿为液态的，仅行微创手术置管引流，容易引出血肿而达到手术目的。而血肿是凝血块时置管不能引出血肿，需开颅清除血肿。笔者把血肿的物理状态分为液化为主型、混合型和血块为主型，利于手术方式的选择。为此，笔者对103例高血压脑出血患者术前行血肿物理状态判断，并与术中所见行对比分析，现将结果报告如下。

1 资料与方法

1.1 一般资料

选择2000年1月-2015年6月103例高血压脑出血手术患者，男59例，女44例，年龄41～89岁，平均65.9岁。……