自发性额颞叶脑内血肿的急救处理

目的 探讨自发性额颞叶脑内血肿的急救处理措施.方法 回顾性分析27例自发性额颞叶脑内血肿合并蛛网膜下隙出血或脑室出血患者的抢救经过及手术经验.23例行外科手术,4例发生脑疝患者急诊在全身麻醉插管下行开颅血肿清除、动脉瘤夹闭术、去骨瓣减压术;7例既往有高血压病史,考虑高血压脑出血,急诊在全身麻醉下行开颅血肿清除、去骨瓣减压术;12例大脑中动脉动脉瘤破裂出血,择机行开颅血肿清除、动脉瘤夹闭术.4例数字减影血管造影（DSA）或CT血管造影（CTA）未发现异常,予以保守治疗,其中1例1个月后复查DSA提示动静脉畸形,予伽马刀治疗.结果 术后因严重脑梗死导致死亡2例,对25例患者随访6个月,按格拉斯哥预后量表（GOS）分级：预后良好17例,预后不良7例,植物状态1例.结论 自发性额颞叶脑内血肿已形成脑疝的病例,应尽快解除脑疝和占位效应,尽早手术挽救生命;对未形成脑疝患者,行DSA或CTA明确诊断后,选择合理的治疗方案.充分的术前评估、合理的手术时机、良好的显微外科手术技巧,能有效改善预后.

Emergency treatment of spontaneous frontotemporal intracerebral hematoma

Objective To investigate the emergency treatment measures of spontaneous frontotemporal intracerebral hematoma.Methods Retrospectively analyzed the rescue process and surgical experiences of 27 patients with spontaneous frontotemporal intracerebral hematoma combined with subarachnoid hemorrhage or ventricular hemorrhage.Twenty-three cases underwent surgery;4 cases with cerebral hernia under general anesthesia underwent craniotomy hematoma clearance,aneurysm clip and decompressive craniectomy;7 cases with previous history of hypertension,considered with hypertensive intracerebral hemorrhage,was performed with craniotomy hematoma clearance and decompressive craniectomy in the emergency under general anesthesia; 12 cases of middle cerebral artery aneurysms bleeding,chosen craniotomy hematoma clearance and aneurysm clip;4 cases found nothing by digital subtraction angiography （DSA） or CT angiography （CTA）,were given conservative treatment,one of them was found arteriovenous malformations after 1 month,which was treated by γ-ray.Results After the surgery,2 cases died due to severe cerebral infarction,25 cases were followed up for 6 months,according to the Glasgow outcome scale（GOS） classification：17 cases with good prognosis,7 cases with poor prognosis,1 case with vegetative state.Conclusions Cerebral hernia formation in patients with spontaneous frontotemporal intracerebral hematoma should relieve cerebral hernia and mass effect as soon as possible,early surgery to save lives.Which of them without brain hernia,after diagnosis by CTA or DSA,choice suitable treatment.Sufficient preoperative evaluation,suitable surgical timing and good microsurgical techniques can improve the prognosis.