基底节区高血压脑出血外科治疗探析

发布时间：2018-08-23 11:42

【摘要】：目的：对基底节区高血压脑出血病例的临床治疗和随访研究,探讨基底节区高血压脑出血(40-70ml)患者不同治疗方法的临床疗效。方法：通过回顾分析广西医科大学附属第一医院神经外科及神经内科2012年6月-2014年10月收治的确诊为基底节区高血压脑出血,年龄在40-70岁,出血量在40-70ml,无大量出血破入脑室、无严重器质性病变及凝血功能异常、脑疝病人的临床表现、影像学资料及治疗方法。比较两组患者的治疗前、治疗后1天、治疗后一周及治疗后6个月末血肿量变化、意识恢复、死亡率及治疗后6个月疗效等情况,分析2组疗效。结果：研究组(手术治疗组)病人57例,对照组(保守治疗组)病人39例。两组入院时情况(年龄、出血量、GCS评分),无统计学差异(P0.05)。1、起病1周后,研究组患者GCS评分显著高于对照组患者(P0.05)。证实手术治疗基底节区高血压脑出血在意识恢复方面强于保守治疗。2、外科术后1周和保守治疗后1周,研究组较对照组患者血肿量明显减少,两组患者的血肿量变化差异显著(P0.05)。表明手术治疗基底节区高血压脑出血在清除血肿方面强于保守治疗。3、研究组死亡9例,死亡率15.79%,对照组死亡17例,死亡率43.59%。两组间差异显著(P0.05),表明手术治疗对比保守治疗可显著降低死亡率。4、研究组预后良好35例(60.34%),对照组预后良好14例(35.90%)。两组间差异显著(P0.05)。表明研究组预后优于对照组。结论：行开颅经外侧裂显微镜下血肿清除术治疗出血量在40-70m1,年龄在40-70岁之间的基底节区高血压脑出血患者的疗效可靠,治疗后患者血肿量变化、意识恢复、死亡率及6个月疗效等均优于保守治疗。
[Abstract]:Objective: to investigate the clinical treatment and follow-up of hypertensive intracerebral hemorrhage (40-70ml) in basal ganglia region. Methods: the diagnosis of hypertensive intracerebral hemorrhage in basal ganglia was analyzed retrospectively in the Department of Neurosurgery and Neurology of the first affiliated Hospital of Guangxi Medical University from June 2012 to October 2014. The age was 40-70 years old and the amount of bleeding was 40-70 ml. No severe organic lesions, coagulation abnormalities, brain hernia, clinical manifestations, imaging data and treatment methods. The changes of hematoma volume, consciousness recovery, mortality and curative effect were compared between the two groups before, 1 day, 1 week and 6 months after treatment. Results: there were 57 cases in the study group and 39 cases in the control group. There was no significant difference between the two groups on admission (age, bleeding volume and GCS score) (P0.05). One week after onset, the GCS score of the patients in the study group was significantly higher than that in the control group (P0.05). The results showed that the recovery of consciousness of hypertensive intracerebral hemorrhage in basal ganglia region was stronger than that in conservative treatment. 1 week after surgery and 1 week after conservative treatment, the hematoma volume in the study group was significantly lower than that in the control group, and the difference between the two groups was significant (P0.05). The results showed that the operative treatment of hypertensive intracerebral hemorrhage in basal ganglia area was stronger than that in conservative treatment. The death rate was 15.79 in the study group and 17 in the control group. The mortality rate was 43.59 in the study group. The difference between the two groups was significant (P0.05), which indicated that the operative treatment compared with conservative treatment could significantly reduce the mortality rate of .4. the prognosis of 35 cases (60.34%) in the study group and 14 cases (35.90%) in the control group were good. There was significant difference between the two groups (P0.05). The prognosis of the study group was better than that of the control group. Conclusion: the treatment of hematoma clearance under the microscope through craniotomy is reliable in patients with hypertensive intracerebral hemorrhage in basal ganglia between 40 and 70 years old. After treatment, the hematoma volume changes and consciousness recovers in patients with hypertensive intracerebral hemorrhage in basal ganglia. The mortality and 6 months curative effect were superior to conservative treatment.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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