广州医科大学学报

目的:探讨颅内血肿微创清除术治疗高血压脑出血的疗效、手术适应证、手术时机及再出血的原因与防治。方法:收集本院43例采用YL-1型颅内血肿穿刺针治疗高血压脑出血患者的临床资料进行回顾性分析,分别比较超早期手术组与早期手术组的术后再出血率、病死率、术后30d恢复良好率。结果:43例中术后生存38例,死亡5例,总病死率11.62%。两组患者的病死率及术后30d恢复良好率差异无统计学意义(P>0.05),超早期手术组的再出血率比早期手术组明显增高(33.3%vs3.6%,P<0.05)。结论:颅内血肿微创清除术是治疗高血压脑出血较有效的方法,发病后6～24h是手术的最佳时间窗,再出血风险增加可能与过早手术(<6h)和首次抽吸量过大(>60%)有关。

Objective:To investigate the therapeutic effects,surgical indications and timing in minimally invasive removal of intracerebral hematoma secondary to hypertensive cerebral hemorrhage,as well as the causes,prevention and treatment of recurrent bleeding.Methods:Clinical data on 43 patients with hypertensive cerebral hemorrhage treated by YL-1 puncture hematoma evacuation were studied retrospectively.Post-procedural relapse of bleeding,mortality,and rate of good recovery on the 30th day were compared between ultra-early vs early treatment.Results:Of the 43 patients with hypertensive cerebral hemorrhage,38 survived and 5 died(11.62%).The mortality rate and good recovery rate on the 30th day were not remarkably different between the two groups.Relapse of post-procedural bleeding rate was seen more in those with ultra-early treatment than early surgery(33.3% vs 3.6%,P<0.05).Conclusion:The minimally invasive surgery for intracranial hematoma appeared to be an effective treatment with hypertensive cerebral hemorrhage.The optimal operative window was 6 to 24 hours after onset.The risk of post-surgical relapse of bleeding might be increased with operation within 6 h after onset and the volume of first drainage >60%.