【摘要】 目的探讨立体定向颅内血肿穿刺引流术超早期(6 h以内)手术与延期(24 h以后)手术治疗高血压性脑出血的疗效。方法选择65例高血压性脑出血患者采用立体定向颅内血肿穿刺引流术清除血肿,根据出血量、部位和血肿形态的不同,选择相应的靶点进行手术治疗。其中超早期手术30例,延期手术35例,术后应用尿激酶血肿腔内注射引流治疗。结果超早期手术患者死亡3例,死于再次出血,总病死率为10%;其余患者术后第3天血肿清除量达到80%的25例,患者术后6个月日常生活能力(ADL)预后评价恢复良好20例(67%)。延期手术患者死亡1例,死于呼吸循环衰竭,总病死率为2.8%;其余患者术后第3天血肿清除量达到90%的30例,患者术后6个月日常生活能力(ADL)预后评价恢复良好27例(77%)。结论立体定向颅内血肿穿刺引流延迟手术安全、有效,对患者的预后良好,再次出血率明显降低。更多还原

【Abstract】 Objective To explore the efficacy of early (within 6 hours) or delayed (after 24 hours) stereotactic intracranial hematoma puncture and drainage surgeries in the treatment of hypertensive cerebral hemorrhage.Methods A total of 65 patients with hypertensive cerebral hemorrhage were given a stereotactic intracranial hematoma puncture and drainage surgery at different targets according to the amount,location and shape of a hematoma,with 30 cases undergoing an early surgery and 35 cases a delayed one.After the surgery,all patients were treated with urokinase injection to drain the hematoma.Results Three patients died of re-bleeding after an early surgery,with a total fatality rate of 10%.Among the other patients,the hematoma clearance reached 80% in 25 patients on the third day after surgery,and 20 patients (67%) recovered well in the ability of daily living (ADL) after six months.One patient died from respiratory and circulatory failure after a delayed surgery,with a total fatality rate of 2.8%.Among the other patients,30 patients had 90% hematoma clearance on the third day after surgery,and 27 patients (77%) had a good recovery in the ability of daily living (ADL) after six months.Conclusion The delayed stereotactic intracranial hematoma puncture and drainage surgery is safe and effective,and has a good prognosis for patients and a significantly lower rate of re-bleeding.更多还原