摘要
目的：研究血肿穿刺引流＋开颅血肿清除内减压两种手术方式序贯治疗重症基底节区高血压脑出血后，脑血流变化情况及与手术效果及预后关联性，探讨两种手术方式序贯治疗重症基底节区高血压脑出血的可行性。方法收集2006年1月-2013年6月在邯郸市中心医院手术治疗的180例重症基底节区高血压脑出血患者的临床资料，按手术方式分为序贯手术治疗组（60例）与大骨瓣开颅组（120例）。观察比较两组术前及术后，使用经颅多普勒（TCD）超声动态监测大脑中动脉的平均流速（Vm）、搏动指数（PI）值。结果重症基底节区高血压脑出血后TCD显示脑血流发生改变，其波谱形态与临床症状及手术疗效有关。序贯手术治疗组术后第7、14天 Vm、PI值、病死率及疗效明显优于大骨瓣开颅组，差异有统计学意义（P〈0.05）。结论血肿穿刺引流＋开颅血肿清除内减压两种手术方式序贯治疗的患者脑血流灌注情况及手术疗效均优于常规大骨瓣开颅血肿清除术，在危重高血压脑出血患者的抢救中，是一种行之有效的手术方法。
Objective To study association of cerebral blood flow and operation curative effect and prognosis after se-quential operation including puncture drainage and evacuation of hematoma treating severe basal ganglia hemorrhage and discuss the feasibility of sequential treatment of severe hypertensive basal ganglia intracerebral hemorrhage. Methods From January 2006 to November 2013, in the Central Hospital of Handan City, the data of 180 patients with serious hypertensive cerebral hemorrhage in basal ganglia were collect, and divided into the sequential therapy group （60 cases） and the large craniectomy group （120 cases）, monitored mean velocity （Vm） and pulsatility index （PI） of the middle cerebral artery by using TCD before and after surgery were observed and compared. Results TCD indicated the cerebral blood flow changed after serious hypertensive cerebral hemorrhage in basal ganglia. The spectral shape was associated with clinical symptoms and operation effect. After operation 7, 14 days PI, Vm value, mortality and the cura-tive effect of sequential therapy group were better those of the large craniectomy group, the differences were statistically significant （P〈0.05）. Conclusion The cerebral blood perfusion and curative effect of sequential therapy is significantly better than large craniectomy. In rescuing the patients with severe hypertensive cerebral hemorrhage, it is an effective operation method.
出处
《中国医药导报》
CAS
2014年第24期59-62,66,共5页
China Medical Herald
基金
河北省邯郸市科学技术与发展计划项目(编号1123108080-15)
关键词
高血压脑出血
血肿清除术
手术序贯治疗
经颅多普勒
手术效果
Hypertensive cerebral hemorrhage
Evacuation of hematoma
Sequential operation
Doppler transcranial
Operation effect
