【摘要】 目的 比较钻孔引流尿激酶溶解术和小骨窗开颅术治疗高血压脑出血的疗效。 方法 2008年9月-2009年12月分别接受钻孔引流尿激酶溶解术（A组，n=34）和小骨窗开颅术（B组，n=30）的高血压脑出血患者共64例（出血量30~50 mL，无脑疝），两组患者术前基线指标（如出血量、手术时机、昏迷程度等）比较无统计学意义。比较接受不同术式的两组患者手术时间、术后1个月的近期疗效、术后6个月远期疗效及死亡率。 结果 A组手术时间短于B组，两组比较，有统计学意义（Plt;0.05）。术后1、6个月，A组疗效优于B组，两组比较，有统计学意义（Plt;0.05）。A、B组术后近期和远期死亡率比较，无统计学意义（Pgt;0.05）。 结论 对出血部位在基底节区、出血量在30~50 mL，无脑疝的高血压脑出血患者，钻孔引流尿激酶溶解术的疗效明显优于小骨窗开颅术。【Abstract】 Objective To compare the therapeutic effect of drill drainage-urokinase perfusion (group A) and small bone flap craniotomy on hypertensive intracerebral hemorrhage. Methods A total of 64 patients with hypertensive intracerebral hemorrhage (about 30-50 mL) from September 2008 to December 2009 were collected. The patients underwent drill drainage-urokinase perfusion (group A,n=34) and small bone flap craniotomy (group B,n=30). The therapeutic effects, including operating time, short-term effect within one month, long-term effect six months after operation, operation time, and the rate of rehaemorrhagia and mortality were observed and the results of the two groups were compared. Results The operation time was shorter in group A than that in group B (Plt;0.05); one month and six months after the operation, the therapeutic effects were better in group A than those in group B (Plt;0.05); the difference in mortality between the two groups was not significant (Pgt;0.05). Conclusion The therapeutic effect of drill draiage-urokinase perfusion is better than that of small bone flap craniotomy on the patients with hypertensive intracerebral hemorrhage in basal unclei with bleeding amount of 30-50 mL and without cerebralhern.
目的:探讨双侧慢性硬膜下血肿(BCSDH)的诊断和治疗。方法:对25例老年患者BCSDH的诊断,治疗资料总结分析,全部病例均行CT/或MRI检查。所有患者皆行颅骨钻孔引流术,其中5例单侧钻孔引流,20例双侧钻孔引流。结果:全部病例均治愈,随访未见复发。结论:CT和MRI检查是BCSDH的最佳诊断手段。钻孔引流是BCSDH的有效治疗方法。
目的:改良钻孔引流术治疗慢性硬膜下血肿27例,提高临床治疗效果。方法:术中可控下持续生理盐水冲洗后,加入尼莫地平注射液排空,术后低渗或等渗液体维持脑灌注压。结果:27例慢性硬膜下血肿经上述措施处理后,经随访均达到满意临床治疗效果。结论:慢性硬膜下血肿钻孔引流术中加用尼莫地平注射液冲洗、排气,及规范化术后处理措施可提高临床疗效。