李金亮

[摘要]目的 探讨不同手术方式对高血压脑出血的临床效果。方法 以2013年1月～2016年1月在我院接受手术治疗的129例高血压脑出血患者作为研究对象，采用随机数字表法，将患者分成A、B、C组，每组43例。A组患者采用大骨瓣开颅血肿清除手术进行治疗；B组患者采用小骨窗显微血肿清除手术进行治疗；C组患者则采用微创穿刺清除术进行治疗。比较三组患者的手术相关指标、临床效果以及并发症发生率。结果 C组患者的手术时间、住院时间明显短于A、B组，术中出血量明显少于A、B组，B组患者的住院时间、手术时间明显短于A组，术中出血量明显少于A组；C组患者的治疗总有效率明显高于A、B组，B组患者的总有效率明显高于A组（P<0.05）。三组患者的术后并发症发生率差异无统计学意义（P>0.05）。结论 治疗高血压脑出血的三种治疗方式在临床效果、手术相关指标等方面存在明显差异，微创穿刺清除术的治疗效果明显优于大骨瓣开颅血肿清除手术以及小骨窗显微血肿清除手术，值得在临床治疗中进一步完善、推广。

[关键词]高血压；脑出血；手术方式

[中图分类号] R743.34 [文献标识码] A [文章编号] 1674-4721（2017）08（a）-0045-03

[Abstract]Objective To explore the effect of different surgical methods on hypertensive intracerebral hemorrhage.Methods A total of 129 patients with hypertensive intracerebral hemorrhage who underwent surgical treatment from January 2013 to January 2016 were selected as objects.Patients were divided into three groups：group A，B and C by random number table method，and there were 43 cases in each group.Patients in group A were given large bone flap craniectomy surgery，group B was given small bone window micro-hematoma removal surgery，while group C was given minimally invasive puncture surgery.The related indexes of operation and clinical effect and the incidence rate of occurrence of patients among three groups were compared.Results The operation time and hospitalization time of group C were significantly shorter than those of group A and group B，and the intraoperative blood loss of group C was significantly less than that of group A and group B，and the total effective rate in patients of group C was significantly higher than that of group A and group B，and the total effective rate in group B was significantly shorter than those of group A （P<0.05）.There was no statistically significant difference for incidence rate of complications among the three groups （P>0.05）.Conclusion Three types of treatment of hypertensive cerebral hemorrhage，there are significant differences in the clinical effect，related indicators of surgery and so on.The treatment effect of minimally invasive surgery is significantly better than the large bone flap craniectomy surgery and small bone window craniotomy hematoma removal surgery.It is worthy of improvement and promotion in clinical treatment.

[Key words]Hypertension；Cerebral hemorrhage；Operation mode

高血壓脑出血是神经科较常见的一种急危重病症，该病在临床治疗中的致死率、致残率均相对较高，采取内科保守治疗的方式患者的死亡率甚至高达50%以上[1]，采取常规的外科手术治疗，患者的预后病死率仍然在30%以上[2]。治疗高血压脑出血的常规原则是在患者发病初期迅速将清除血肿，目前的治疗方式主要有大骨瓣开颅血肿清除术、小骨窗显微血肿清除术、微创穿刺清除术三种主要的外科方式，但是对于以上三种手术形式的临床效果的认定，还没有一个统一的、权威的认定。……