高血压脑出血手术方式选择的临床研究

发布时间：2018-03-19 13:32

本文选题：高血压脑出血　切入点：手术方式　出处：《第四军医大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景高血压脑出血(Hypertensive intracerebral hemorrhage,HICH)是当前威胁人类生命的主要疾病之一,提高脑出血的研究治疗水平已经受到国内外的普遍关注和重视,特别是近年来受到神经外科的广泛关注[1-3]。引起脑出血的危险因素很多,其中高血压在脑出血的发生过程中占的比重较大。国内流行病学调查,脑出血发病率占脑卒中的17.1%~55.4%,明显高于国外6.5%~19.6%的水平。急性期脑出血病死率为30%~40%,预后极差[4],是目前严重危害人类健康的常见疾病。在神经外科,虽然人们对脑出血的治疗在手术方法的选择上趋于一致,但仍有一些争议,包括手术时机,手术方式的选择等方面,而目前我国又在高血压脑出血外科手术术式选择方面缺乏详细的规范,并缺乏较为全面的疗效对比研究。目的探讨高血压脑出血手术方式的选择及其治疗效果。方法选择解放军第三医院2012年11月-2013年10月204例脑出血手术患者(细化组),按照我们事先设计的6种脑出血手术方式的适应症,采取相应的手术方式治疗;另回顾分析2011年10月至2012年10月216例脑出血手术患者资料(传统组),本组患者是经验性地采取钻孔血肿引流、微创开颅血肿清除、开颅血肿清除并去骨瓣减压三种手术方式。对比两组患者治疗手术方式导致的差异。结果1、细化组与传统组术前患者的性别、年龄、是否合并慢性病史,以及患者的意识状态、出血部位、出血量两组之间比较无统计学意义(P0.05)),说明细化组与传统组患者术前状况无差异。两组患者均采用了标准的药物治疗,药物治疗和抢救治疗方面无显著差异。2、细化组钻孔后再出血为24.68%,传统组钻孔后再出血为38.78%。c2=3.903,P0.05,两组差异有统计学意义,细化组再出血率低于传统组。3、去骨瓣减压术后的死亡率比较,细化组为39.29%,传统组为61.82%。c2=5.636,P0.05,两组差异有统计学意义,细化组死亡率低于传统组。4、两组病例术后1个月死亡率比较,细化组死亡48例(23.53%),传统组死亡78例(36.11%),两者之间比较,c2=7.908,P0.05,差异有统计学意义,说明细化组治疗死亡率明显低于传统组。5、术后3月根据改良Rankin量表(Modified Rankin Scale,m RS)在术后3月给予患者预后量表评定。术后1-3月细化组死亡4例,传统组死亡2例。c2=3.378,P0.05,两组预后差异无统计学意义。结论:高血压脑出血选择恰当的手术方式,对脑出血患者的治疗及愈后有显著意义。
[Abstract]:Background Hypertension intracerebral hemorrhage (HICH) is one of the main diseases threatening human life at present. Especially in recent years, neurosurgery has paid close attention to [1-3] .There are many risk factors for intracerebral hemorrhage, in which hypertension accounts for a large proportion in the process of cerebral hemorrhage. The incidence of intracerebral hemorrhage (ICH) accounts for 17.1% of stroke, which is significantly higher than that of 6.555% in foreign countries. In neurosurgery, the mortality rate of ICH in acute stage is 30%, and the prognosis is very poor [4], which is a common disease that seriously endangers human health at present. Although the treatment of intracerebral hemorrhage tends to be consistent in the choice of surgical methods, there are still some controversies, including the timing of the operation, the choice of surgical methods and so on. At present, there is a lack of detailed rules on the selection of surgical procedures for hypertensive intracerebral hemorrhage in China. Objective to explore the choice of surgical methods for hypertensive intracerebral hemorrhage and its therapeutic effect. Methods 204 patients with intracerebral hemorrhage were selected from November 2012 to October 2013 in the third Hospital of PLA. Group A, according to the indications of the 6 types of intracerebral hemorrhage operations we designed beforehand, The data of 216 patients with intracerebral hemorrhage from October 2011 to October 2012 were retrospectively analyzed. Results 1. The gender, age, history of chronic disease and consciousness of the patients in the two groups were refined before operation. There was no significant difference in the bleeding location and bleeding volume between the two groups, indicating that there was no difference in preoperative status between the patients in the refined group and the traditional group. The patients in both groups were treated with standard drugs. There was no significant difference between drug therapy and rescue treatment. The rebleeding after drilling in the fine group was 24.68, and that in the traditional group was 38.78. C23903P0.05. There was significant difference between the two groups. The rate of rebleeding in the refined group was lower than that in the traditional group, and the mortality rate after decompression of bone flap was lower than that in the control group. 39.29 in the fine group and 61.82 in the traditional group. The difference between the two groups was statistically significant. The mortality rate in the refined group was lower than that in the traditional group. The mortality rate of the two groups was lower than that of the traditional group, and the mortality rate of the two groups was 1 month after operation. 48 cases died in the refined group and 78 cases in the traditional group. The difference between the two groups was statistically significant. The results showed that the mortality rate in the refined group was significantly lower than that in the traditional group. On March, the patients were evaluated with the prognosis scale according to the modified Rankin scale modified Rankin Scalem RSs. 4 patients died in the refined group in 1-3 months after operation. There was no significant difference in prognosis between the two groups. Conclusion: the choice of appropriate operation method for hypertensive intracerebral hemorrhage is significant for the treatment and recovery of cerebral hemorrhage patients.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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