CAJ | 학술논문

目的探讨以微创理念指导高血压基底节脑出血的手术治疗对其预后的影响. 方法将仙游县医院自2007年1月至2011年6月收治的高血压基底节脑出血手术患者57例分为2008年12月以前收治的A组(26例,根据血肿量来判断手术指征,具备手术指征者予术前准备并手术治疗)和2008年12月以后收治的B组(31例,有血肿扩大趋势者即予术前准备,以微创的理念指导手术行血肿彻底清除并妥善止血),分析在微创理念指导下以血肿扩大趋势为手术依据并手术行血肿彻底清除、妥善止血对高血压基底节脑出血预后的影响. 结果术前意识状态分级及血肿量在2组间比较差异无统计学意义(P＞0.05).A组发现15例有责任血管,B组发现27例,比较差异有统计学意义(P＜0.05).A组血肿清除率约为75％,术后近期再出血4例(15.4％)；B组血肿清除率＞90％,术后近期再出血2例(6.5％),均为未找到责任血管者.A组术后3个月良好率为46.2％(12/26),B组为74.2％(23/31),比较差异有统计学意义(P＜0.05). 结论以微创理念指导高血压基底节脑出血的手术治疗,把血肿扩大趋势作为手术依据,尽快发现有手术适应证者,并在最短时间内手术,手术讲究彻底清除血肿、妥善止血,从而能有效改善其疗效.
목적 탐토이미창이념지도고혈압기저절뇌출혈적수술치료대기예후적영향. 방법 장선유현의원자2007년1월지2011년6월수치적고혈압기저절뇌출혈수술환자57례분위2008년12월이전수치적A조(26례,근거혈종량래판단수술지정,구비수술지정자여술전준비병수술치료)화2008년12월이후수치적B조(31례,유혈종확대추세자즉여술전준비,이미창적이념지도수술행혈종철저청제병타선지혈),분석재미창이념지도하이혈종확대추세위수술의거병수술행혈종철저청제、타선지혈대고혈압기저절뇌출혈예후적영향. 결과 술전의식상태분급급혈종량재2조간비교차이무통계학의의(P＞0.05).A조발현15례유책임혈관,B조발현27례,비교차이유통계학의의(P＜0.05).A조혈종청제솔약위75％,술후근기재출혈4례(15.4％)；B조혈종청제솔＞90％,술후근기재출혈2례(6.5％),균위미조도책임혈관자.A조술후3개월량호솔위46.2％(12/26),B조위74.2％(23/31),비교차이유통계학의의(P＜0.05). 결론 이미창이념지도고혈압기저절뇌출혈적수술치료,파혈종확대추세작위수술의거,진쾌발현유수술괄응증자,병재최단시간내수술,수술강구철저청제혈종、타선지혈,종이능유효개선기료효.
Objective To investigate the influence of surgery with the guideline of minimally invasive concept in prognosis of patients with hypertensive basal ganglia hematomas. Methods Fifty-seven patients with hypertensive intra-cerebral hemorrhage were randomly divided into 2 groups:Group A (admitted to our hospital from January 2007 to December 2008 and performed surgery under the condition that the content of hematoma reached the level for surgery,n=26) and Group B (admitted to our hospital from January 2009 to June 2011 and received surgery with the guideline of minimally invasive concept once noting the tendency ofexpanded hematoma,n=31).We evaluated the influence of surgery (total removal of the hematoma and proper stopping the bleeding) according to the condition that tendency of expanded hematoma appeared and with the guideline of minimally invasive concept in the prognosis of these patients. Results No significant differences in consciousness classification and hematoma volume before surgery were noted between the 2 groups (P＞0.05).Responsible vessels were noted in 15 patients from Group A and 27 patients from Group B, and significant difference was noted between these 2 groups (P＜0.05).The hematoma clearance rate was 75％ in Group A,and re-bleeding was noted in 4 patients (15.4％) after the surgery; while that was higher than 90％ in Group B, and re-bleeding was only noted in 2 patients (6.5％) whose responsible vessels could not be found.The good recovery rate in Group A was 46.2％ 3 months after surgery, while that in Group B was 74.2％, which indicated that the effect in group B was obviously better than that in group A (P＜0.05). Conclusion Tendency of expanded hematoma should be paid attention in patients with hypertensive basal ganglia cerebral hemorrhage; it is important to quickly identify the cases showing clear indications for surgery and to perform the procedures at the earliest time; the procedures, including completely removal of the hematoma and properly stopping the stanch bleeding under direct vision with the guideline of minimally invasive concept can improve the recovery fiom hypertensive basal ganglia cerebral hemorrhage.