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【摘要】 目的 探讨微创穿刺引流术治疗高血压脑出血的临床效果。方法 80例高血压脑出血患者随机分为观察组及对照组各40例，比较两种治疗方法的病死率以及总有效率。结果 观察组总有效率72.5%，高于对照组的42.5% (P<0.05)，且观察组病死率明显低于对照组(P<0.05);观察组术后无1例感染，发生再出血2例。结论 颅内血肿微创穿刺治疗高血压脑出血有较高的临床实用价值，疗效明显优于内科保守治疗，值得基层医院推广应用。
【关键词】 高血压; 脑出血; 微创穿刺
Clinical research of applying miniinvasive puncture and drainage in the treatment of hypertensive cerebral hemorrhage WU Haiqing.Shijie Hospital, Dongguan 523000,China
【Abstract】 Objective To explore the clinical efficiency of miniinvasive puncture and drainage in the treatment of hypertensive cerebral hemorrhage.Methods 80 cases of hypertensive cerebral hemorrhage were randomly divided into the miniinvasive group and 40 cases of the control group to compare the death rate and the total effective rate between the two methods. Results The effective rate in the therapy group (72.5%)was significantly higher than that of the control group (42.5%，χ2 = 8.12,P<0.05) and the morality in the treatment was significantly lower than that of the control group. There was not any case of infection,but there were 2 cases of rehaemorrhagia. Conclusion Miniinvasive treatment of intracranial hematoma puncture of hypertensive intracerebral hemorrhage has a higher value in the clinical application, whose efficacy is superior to conservative medical treatment, and it is worth promoting in the grassroots hospital.
【Key words】 Hypertension;Cerebral hemorrhage;Miniinvasive puncture
近年来我科采用YL1型穿刺针局麻下行微创穿刺颅内血肿引流-尿激酶液化血肿手术治疗高血压脑出血，创伤小，病人家属易接受，具有操作简单、安全、实用、手术时间短、效果好等优点。我院对40例高血压脑出血患者行微创穿刺引流，取得了显著疗效医.学全.在.线网站www.lindalemus.com。
1 资料与方法
1.1 一般资料 我院2002年5月～2009年1月共收治出血量≥25 ml的高血压脑出血患者80例， 随机分为观察组及对照组，观察组行微创穿刺引流术共40例，男22例，女18例，年龄40～78岁;对照组行内科保守治疗共40例，男25例，女15例，年龄45～76岁。出血部位：观察组丘脑基底节15例、内囊10例、外囊13例、皮质下2例;对照组丘脑基底节16例、内囊18例、外囊2例、皮质下4例。两组病例年龄、性别、出血部位具有可比性。
1.2 临床表现 患者均为突然发病，失语8例，恶心、呕吐13例。其中昏迷19例，头痛伴一侧肢体瘫痪22例。一侧瞳孔散大22例，双侧瞳孔散大4例。
1.3 治疗方法 两组患者均常规行脱水、调整血压、保护脑细胞、预防及处理并发症等内科治疗。观察组行微创穿刺引流术：血肿穿刺在床旁操作，患者取卧位，根据头颅CT确定穿刺点和穿刺深度，以出血量最多、血肿最接近颅骨的CT层面为穿刺点，并避开大脑中动脉及重要功能区。局麻锥颅钻孔后，用导丝引导内径3.5 mm硅胶管直接穿刺，进入血肿腔中心后，拔出导丝，连接注射器，抽吸血肿液，第1次清除血肿总量的20%～40%，以后根据病情注入尿激酶盐水溶解凝固血块，1～2次/d，每次夹管4～6 h后开放引流，待血肿清除达70%～80%时即可拔管，一般引流3～6 d。
1.4 疗效评定标准 按全国第四届脑血管病学术会议通过的脑卒中患者临床神经功能缺损程度评分标准(CSS)[1]进行评分。
