【作者】 左右；

【导师】 陈建良； 吴耀晨； 陈洪； 向进；

【作者基本信息】 暨南大学 ， 外科学， 2005， 硕士

【摘要】 目的:初步探讨小骨窗开颅显微血肿清除术治疗高血压脑出血(HICH)的近期手术疗效(术后30d),客观评价此手术方式的优缺点。全面分析影响近期手术疗效的有关因素,初步制定出本术式治疗适应症,以提高手术效果。 方法:106例采取小骨窗显微血肿清除术治疗的HICH患者临床资料,包括年龄、性别、出血部位、血肿量、血肿形态、血肿破入脑室情况、发病至手术时间(T)、术前意识分级、GCS评分、平均动脉压(MAP)、血糖值、手术者、术后并发症、血肿复发率等14种因素。统计学分析各因素对近期手术疗效的影响,并从血肿清除率、再出血率、不同病情的死亡率、并发症发生率、手术安全性、住院时间及费用等方面,客观评价本术式的优缺点。结合统计学分析结果,分别对近期手术疗效有重要影响的因素进行讨论。 结果:本组血肿清除率79.3%,再出血率10.4%,并发症发生率25.5%,住院时间缩短。总体死亡率为27.4%(29/106),按术前意识状态分级,Ⅰ级无死亡、Ⅱ级15.4%、Ⅲ级14.3%、Ⅳ级28.6%、Ⅴ级64.0%。单因素分析:术前MAP、意识状态分级、GCS值、血肿形态、出血部位、血肿量、血肿是否破入脑室、血肿是否复发、及术后并发症等有统计学意义(P<0.05)。多因素Logistic回归分析:意识状态分级、术后并发症、出血部位有统计学意义(P<0.10)。 结论:小骨窗显微血肿清除术是一种较好的微创方法,其疗效确切,值得推广应用。意识状态分级、术后并发症、出血部位、GCS值、血肿形态、血肿量、血肿是否破入脑室、血肿是否复发等是影响近期手术疗效有的重要因素。其中,前3个最为重要,可作为评价本术式治疗HICH近期预后的重要指标。根据病人病情及CT表现选择手术方式、术中细致操作、术后精心管理是提高手术疗效及其安全性的关键。更多还原

【Abstract】 Objective To primary investigate the early effect(in 30 days post operation) of hypertensive intracerebral hemorrhage(HICH) treated by microsurgery with small craniotomy, objective appraise the merits and defects of the procedure, and generally analyse the factors which influence operative effect, and primary draw the operation signs.Methods The clinic data of 106 patients suffering from HICH treated by microsurgery with small craniotomy, including age, sex, locations of hematoma, volume of hematoma, shape of hematoma, whether hematoma break into ventricle or not, time from illness onset to operation(T), consciousness state grade before operation, GCS, mean artery pressure(MAP), value of blood sugar, operators, complications post-operation, and hematoma recur, whose influence to early operative effect was analysed with statistic methods. Objective appraised the merits and defects of the procedure at the hematoma elimination rate, the rate of hematoma recur, the mortality in different grades of morbid state, the rate of complications happen, the operation security, the days in hospital, and the therapy charge. Combining with statistic results, analysed the factors which influence early operative effect, respectively.Results The hematoma elimination rate was 79.3%, the rate of hematoma recur was 10.4%, and complications rate was 25.5%, the days in hospital was less than before. The total mortality was 27.4% (29/106), grade Ⅰ had no death grade Ⅱ 15.4%, grade Ⅲ 14.3%, grade Ⅳ 28.6%, grade Ⅴ 64.0%. Univariate analysis results: MAP, GCS, consciousness state grade, shape of hematoma, locations of hematoma, volume of hematoma, whether hematoma break into ventricle or not, hematoma recur, and complications post-operation had statistic significance (P<0.05). Multivariate Logistic regression results: consciousness state grade, complications after operation, and locations of hematoma had statistic significance (P<0.10).Conclusions Microsurgery with small craniotomy is a better minimally invasive method, its effect is affirmative, and it deserves popularizing. Consciousness state grade, complications post-operation, locations of hematoma, GCS, shape of hematoma, volume of hematoma, whether hematoma break into ventricle or not, and hematoma recur are important factors which effect the prognosis, but anterior 3 factors are the most important indexes which we estimate the prognosis of HICH treated by microsurgery with small craniotomy. Strictly choosing patients according all factors before operation, carefully handling in operation, and exactly administrating patients after operation are pivotal to improve operative effect and security.更多还原