高血压脑出血3种治疗方法比较

目的:观察高血压脑出血采用外科微创治疗、开颅清除术及保守治疗的临床疗效。方法:将80例高血压脑出血患者按治疗方法的不同,分为颅内血肿微创清除术组(微创组)35例,开颅治疗组(开颅组)30例和内科保守治疗组(内科组)15例,3组患者给予常规治疗,包括吸氧、保持呼吸道通畅、降颅压、调整血压以及预防感染、消化道出血、肾功能衰竭等并发症。开颅组在此基础上行开颅手术治疗,微创组在此基础上行颅内血肿微创清除术。比较观察3组的临床疗效、并发症发生率,死亡率及病残率。结果:微创组总有效率为82.9%,较开颅组(56.7%)和内科组(33.3%)明显提高,差异有统计学意义(P<0.05)。微创治疗高血压脑出血可以明显降低患者电解质紊乱,感染,肝、肾功能不全,心律失常和消化道出血的发生率,与开颅组和内科组比较,差异有统计学意义(P<0.05)。同样微创组的病死率较其他两组明显降低,差异有统计学意义(P<0.05)。微创组3个月时患者日常生活活动能力(Barthel指数)较开颅组和内科组明显改善,3组间比较差异有统计学意义(P<0.01)。结论:YL-1型颅内血肿粉碎针行颅内血肿清除术疗效显著,该技术方法先进、操作简便、安全性高、费用较低,值得推广应用。

Control study of hypertensive intracerebral hemorrhage treatment with minimally invasive surgery,craniotomy and conservative treatment

Objective： To evaluate minimally invasive surgery for hypertensive cerebral hemorrhage and its complications′ observation in the use of CT positioning.Methods： According to the different treatments with hypertensive intracerebral hemorrhage,80 patients were divided into minimally invasive removal of intracranial hematoma group（35 cases）,craniotomy group（30 cases） and conservative treatment group（15 cases）.Three groups of patients were given conventional treatment,including oxygen,airway patency,decreasing intracranial pressure,adjusting blood pressure,preventing infection,gastrointestinal bleeding,kidney failure and other complications.Craniotomy craniotomy group performed with craniotomy and the minimally invasive group underwent minimally invasive removal of intracranial hematoma.Clinical efficacy,the rate of complications,morbidity and the rate of disability were compared among three groups.Results： The total effective rate of invasive group（82.9%） was higher than that of craniotomy group（56.7%） and medical group（33.3%）,respectively.The difference was statistically significant（P0.05）.Minimally invasive treatment of hypertensive patients with cerebral hemorrhage can significantly reduced the electrolyte disorder,infection,liver,renal insufficiency,arrhythmia and the incidence of gastrointestinal bleeding,the difference was statistically significant（P0.05）.Similarly,mortality in invasive group decreased significantly than the other two groups,the difference was statistically significant（P0.05）.The activities of daily living（Barthel index） in minimally invasive group compared with craniotomy group and medical group at 3 months was improved significantly（P0.01）.Conclusion： Minimally invasive removal of intracranial hematoma with YL-1 type of intracranial hematoma smash needle is effective,simple,safe and cheap,and the technique is advanced,consistent with our national conditions,suitable to carry out a wide range in basic units,it has good social benefits and should be widely applied.