高血压基底节区出血常见术式的疗效分析

发布时间：2018-04-19 15:29

本文选题：基底节区 + 高血压　；参考：《新乡医学院》2015年硕士论文

【摘要】：目的比较经颞叶大骨瓣手术、微创血肿碎吸术及显微镜辅助小骨窗经侧裂开颅术三种术式治疗高血压基底节区出血的临床疗效。方法选择安阳市第三人民医院,2011年4月至2015年4月期间,接受手术治疗患者的临床资料,经颞叶大骨瓣手术38例,微创血肿碎吸术63例,显微镜辅助小骨窗经侧裂开颅术59例。三组病例资料均在手术前按患者的一般特征(性别、年龄)、GCS昏迷评分、出血量、来院时血压、术前准备时间进行均衡性分析,3个月完成随访,通过分析GOS预后评分、病死率,评价疗效。结果1.一般特征(性别、年龄)、术前GCS评分、术前准备时间、出血量(多田公式计算)、来院时血压无统计学差异(P0.05)。2.3个月术后随访GOS评分,经颞叶大骨瓣手术组、微创血肿碎吸组与显微镜辅助小骨窗经侧裂开颅组预后有效率,有统计学差异(P0.05)),表明显微镜辅助小骨窗经侧裂开颅组、微创血肿碎吸术组预后优于经颞叶大骨瓣手术；但显微镜辅助小骨窗经侧裂开颅组和微创血肿碎吸术组预后有效率比较无统计学差异(P0.05)。3.总病死例数33例(20.6%),显微镜辅助小骨窗经侧裂开颅组、微创血肿碎吸术组与经颞叶大骨瓣手术组病死率进一步比较,存在统计学差异(P0.05)；显微镜辅助小骨窗经侧裂开颅组与微创血肿碎吸术组病死率比较,不存在统计学差异(P0.05)。结果表明：显微镜辅助小骨窗经侧裂开颅组、微创血肿碎吸术组病死率均优于经颞叶大骨瓣手术组；但小骨窗经侧裂开颅组较微创血肿碎吸术无明显优势。4.三组中不良预后病例总数70例,其中35例出血量80 ml,占50.0%；33例GCS评分8分,占47.1%。出血量在31～50 ml、51～80 ml,GCS评分9～12分、6～8分的,不良预后率三组间比较存在统计学差异(P0.05)；出血量超过80 ml,GCS评分3～5分的预后不良率三组间比较不存在统计学差异(P0.05),提示出血量超过80 ml,GCS评分3～5分的患者,手术方式的选择对疗效并无明显差别。结论1.显微镜辅助小骨窗经侧裂开颅组与微创血肿碎吸术组预后优于经颞叶大骨瓣手术组；2.出血量80 ml,GCS评分8分,显微镜辅助小骨窗经侧裂开颅对于患者预后存在优势；3.大面积脑出血患者,经颞叶大骨瓣手术在临床的作用不可取代；4.微创血肿碎吸术创伤小,简便易操作,出血量较少患者能获得较好的预后。
[Abstract]:Objective to compare the clinical effects of large temporal lobe bone flap surgery, minimally invasive hematoma crushing and microscopically assisted small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage.Methods from April 2011 to April 2015, the clinical data of 38 patients with large temporal lobe bone flap, 63 patients with minimally invasive hematoma and 59 patients with microscopically assisted small bone window craniotomy were selected from the third people's Hospital of Anyang City from April 2011 to April 2015.The data of the three groups were analyzed according to the general characteristics of the patients before operation (sex, age, GCS coma score, blood loss, blood pressure at hospital, preoperative preparation time, 3 months follow-up, GOS prognosis score, mortality, etc.)To evaluate the curative effect.Result 1.General characteristics (sex, age, preoperative GCS score, preoperative preparation time, bleeding volume (Duotian formula), no significant difference in blood pressure at hospital (P 0.05). 2. 3 months follow-up GOS score, transtemporal lobe large bone flap operation group.The effective rate of prognosis between the minimally invasive hematoma aspiration group and the microscopically assisted small bone window open craniotomy group was significantly different (P 0.05), which indicated that the prognosis of the microinvasive hematoma crushing group was better than that of the large temporal lobe bone flap operation.However, there was no significant difference in the effective rate of prognosis between the microscopically assisted small bone window craniotomy group and the minimally invasive hematoma crushing group (P0.05. 3).The total death rate of 33 cases was 20. 6%. The mortality of microscopically assisted small bone window craniotomy group, minimally invasive hematoma fragmentation group and transtemporal lobe large bone flap group was further compared.There was statistical difference (P 0.05) and there was no significant difference in mortality between the microscopically assisted small bone window craniotomy group and the minimally invasive hematoma aspiration group (P 0.05).The results showed that the mortality of the microscopically assisted small bone window craniotomy group was better than that of the transtemporal lobe large bone flap group, but there was no significant advantage in the small bone window craniotomy group compared with the minimally invasive hematoma fracturing group.There were 70 cases of poor prognosis in the three groups, of which 35 cases had blood loss of 80 ml, accounting for 50.0% and 33 cases with GCS score of 8 points, accounting for 47.1%.The GCS score was 9 ~ 12 and 6 ~ 8, respectively.There was no significant difference in poor prognosis rate among the three groups (P 0.05), and there was no significant difference in the rate of poor prognosis among the three groups with bleeding over 80 ml / g GCS score of 3 ~ 5 points, which suggested that the patients whose bleeding volume exceeded 80 ml / g GCS score were 3 ~ 5 points.There was no significant difference in the outcome of the operation.Conclusion 1.The prognosis of microscopically assisted small bone window craniotomy group and minimally invasive hematoma shredding group was better than that of the large temporal lobe bone flap group.The 80 ml / g GCS score of 80 ml / L and the microscopically assisted craniotomy with small bone window had an advantage in the prognosis of the patients.In patients with massive intracerebral hemorrhage, the clinical effect of large temporal lobe bone flap can not be replaced by 4. 4%.The patients with minimally invasive hematoma crushing and aspiration can obtain better prognosis with small trauma, simple and easy operation and less bleeding.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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