目的 探讨基底节区高血压脑出血手术治疗的时机、方式及疗效。 方法 回顾性分析2006年1月－2011年1月行开颅手术治疗的基底节区高血压脑出血168例患者临床资料。其中男98例，女70例；年龄35～84岁，平均65.2岁。患者发病至入院时间30 min～48 h，平均7.1 h。入院时患者意识状态分级：Ⅰ级32例，Ⅱ级46例，Ⅲ级41例，Ⅳ级28例，Ⅴ级21例。入院头部CT检查示外侧型51例，内侧型71例，混合型46例。血肿量25～50 mL 76例，50～80 mL 53例，＞80 mL 39例。采用小骨窗开颅血肿清除术127例，行骨瓣开颅血肿清除术41例。 结果 168例患者中，死亡16例（9.52%）。术后4～28 h再出血8例，立即再次手术清除血肿6例，非手术治疗2例，致死亡4例；死于血肿量过大或脑疝6例，肺部、尿路感染3例，多器官功能衰竭3例。出院时按格拉斯哥预后量表评分，恢复良好82例，中残46例，重残16例，植物生存8例，死亡16例。术后随访3～6个月，按日常工作能力分级，Ⅰ级33例，Ⅱ级49例，Ⅲ级54例，Ⅳ级8例，Ⅴ级8例。 结论 超早期或早期在直视下手术，彻底清除血肿，术中对出血的责任血管可靠电凝止血，术后再出血发生率低，术后恢复快，疗效满意。
目的 明确异丙酚对于高血压脑出血患者血清炎性细胞因子的影响。 方法 将2008年3月-2009年3月收治的高血压脑出血患者47例分为两组，异丙酚组采用异丙酚、芬太尼、维库溴铵以及异氟醚诱导和维持麻醉；对照组采用依托咪酯、芬太尼、维库溴铵以及异氟醚诱导和维持麻醉。比较两组患者手术中不同时段血清白细胞介素（IL-6）、肿瘤坏死因子（TNF）、血栓素、内皮素、前列腺素E和降钙素水平。 结果 患者麻醉过程中生命体征平稳，无麻醉相关死亡。术前异丙酚组患者血清IL-6、TNF、血栓素、内皮素、前列腺素E和降钙素水平与对照组比较均无差异(P＞0.05)，而麻醉诱导后差异有统计学意义(P＜0.05)，而且差异随时间延长增大。 结论 采用异丙酚麻醉能降低术中血清炎性细胞因子水平。
目的:探讨行气管切开术抢救成功的重型颅脑损伤及高血压脑出血患者直接除管的安全性和可行性。方法:在507监护仪行SPO2监测和严密观察下,不经过试阻管而直接将气管套管拔除。结果:本组除1例患者因带管时间长,切口周围气管内炎性肉芽生长而重新插管外,其余患者呼吸平稳,呼吸道通畅,无呼吸急促、呛咳、紫绀及SPO2降低。结论:此法避免了传统除管前试阻管的繁锁和由阻管而引起的多种不良反应,有临床实用价值。
目的:探讨幕上高血压脑出血手术治疗近期预后的影响因素。方法:回顾经手术治疗的73例幕上高血压脑出血患者的临床资料,分析患者性别、年龄、术前GCS评分、出血部位、术前瞳孔有无散大、出血是否破入脑室、出血量、手术时机8个因素对患者预后的影响。评定患者日常生活能力(ADL)分级,将ADL 1-3级划为预后良好组,ADL 4-6级划为预后差组。结果:预后良好组和预后差组在术前GCS评分、出血量、出血是否破入脑室、术前瞳孔有无散大及手术时机上在统计学上有显著性差异(Plt;0.05),而患者的年龄、性别及出血部位则在统计学上未见显著性差异(Pgt;0.05)。Logistic回归分析,术前GCS评分、出血量、出血是否破入脑室与预后ADL分级相关(Plt;0.05)。其相关系数分别为:-0.456、0.124、0.341。结论:术前GCS评分、出血量、出血是否破入脑室是估计患者手术治疗近期预后有意义的指标,术前瞳孔有无散大、手术时机对评价患者预后有一定的参考价值。了解影响高血压脑出血预后的因素可以更有效的制定治疗方案,估计预后。
ObjectiveTo explore the advantages and operation skills of ultra-early small bone window craniotomy surgery on cerebral hemorrhage in basal ganglia regions. MethodsWe retrospectively analyzed the clinical data of 58 patients with cerebral hemorrhage in basal ganglia regions who underwent ultra-early small bone window craniotomy between January 2009 and December 2012. ResultsPatients within 24 hours after surgery were re-checked by CT scan, which showed that hematoma was cleared in 53 cases, most removed in 2 cases, re-hemorrhage occurred in 2 patients whose hematoma was immediately removed by the original incision, 1 patient had large area infarction and underwent bone flap decompression. According to Glasgow outcome scale score at discharge, the outcome was good in 23, moderate disability in 18, severe disability in 12, persistent vegetative state in 2 and 3 were dead. ConclusionUltra-early skull-window craniotomy can timely and completely remove the hematoma, provide reliable coagulation, protect important arteries with less re-hemorrhage and excellent outcome, which is one of the most effective methods for treating cerebral hemorrhage in basal ganglia regions.
ObjectiveTo systematically review the efficacy between key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. MethodsSuch databases as The Cochrane Library (Issue 3, 2013), PubMed, EMbase, WangFang Data, CNKI and VIP was searched to identify randomized controlled trials (RCTs) on key hole approach versus large trauma craniotomy for patients with hypertensive intracerebral hemorrhage from January 2005 to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 13 studies involving 1 324 patients was included. The results of meta-analysis showed that, key hole approach was superior to large trauma craniotomy with significant differences in the fatality rate (OR=0.29, 95%CI 0.19 to 0.45, P < 0.000 01), incidence of postoperative complications (OR=0.35, 95%CI 0.21 to 0.57, P < 0.000 1), recovery time of consciousness (MD=-4.52, 95%CI-5.84 to-3.20, P < 0.000 01), neurologic impairment score after 1-month treatment (MD=-12.63, 95%CI-16.36 to-8.90, P < 0.000 01), total effectiveness (OR=3.79, 95%CI 2.54 to 5.66, P < 0.000 01), and postoperative living ability (ADL Grade I, Ⅱ). ConclusionKey hole approach is better than large trauma craniotomy for patients with hypertensive intracerebral hemorrhage. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies, especially conducting multicenter blinding RCTs with large sample-size.
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=−3.37, 95%CI −3.89 to −2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.