高血压脑出血脑积水78例的治疗体会

目的]探讨高血压脑出血早期救治和中后期脑积水的诊治的方法与疗效.方法]收集本院78例高血压脑出血出现脑积水患者的临床资料并对其治疗情况进行回顾性分析.结果]78例高血压脑出血出现脑积水的患者中,丘脑出血59例,脑干出血13例,小脑出血6例.所有病例均有出血破入脑室系统,其中侧脑室、第三脑室、导水管及第四脑室全脑室铸型53例;发生颅内感染36例.早期行侧脑室引流、冲洗、尿激酶注入、腰穿治疗,侧脑室引流持续时间7～56 d;中后期出现脑积水46例,均给予侧脑室腹腔分流术.本组病例中中度残废36例,重度残废18例,持续植物状态15例,死亡9例.结论]高血压脑出血发生脑积水与出血部位、出血破入脑室系统和继发颅内感染有关,早期积极引流、预防感染,中后期及时给予侧脑室腹腔分流术有助于改善预后.

Experience of the Treatment of 78 Hypertensive Cerebral Hemorrhage with Hydrocephalus

Objective]To explore the early treatment of hypertensive cerebral hemorrhage and the method of the diagnosis and treatment of middle and late hydrocephalus.Methods] Clinical data of 79 cases of hypertensive cerebral hemorrhage with hydrocephalus in our hospital were collected,and the treatment status was analyzed.Results] Among 78 cases of hypertensive cerebral hemorrhage with hydrocephalus,there were 59 cases of thalamic hemorrhage,13 cases of brain stem hemorrhage and 6 cases of cerebellar hemorrhage.All patients had the hemorrhage breaking into ventricular system,in which 53 patients were ventricular casting in lateral ventricles,third ventricle,aqueduct and fourth ventricle and 36 patients were intracranial infection.All patients were given early drainage of lateral ventricle flushing for continuous 7～56d,urokinase injection and lumbar puncture treatment.Hydrocephalus occurred in 46 patients at middle and later stage,and underwent ventricle peritoneal shunt.Of all patients,36 patients were moderate disability,and 18 patients were severe disability,and 15 patients were persistent vegetative state,and 9 patients were dead.Conclusion] Hypertensive intracerebral hemorrhage with hydrocephalus is correlated with bleeding site,hemorrhage breaking into ventricular system and secondary intracranial infection.Early positive drainage,infection prevention and lateral ventriculoperitoneal shunt in middle and later stage are helpful to improve the prognosis.