本文選題：高血壓腦出血　切入點(diǎn)：手術(shù)方式　出處：《第四軍醫(yī)大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景高血壓腦出血(Hypertensive intracerebral hemorrhage,HICH)是當(dāng)前威脅人類生命的主要疾病之一,提高腦出血的研究治療水平已經(jīng)受到國內(nèi)外的普遍關(guān)注和重視,特別是近年來受到神經(jīng)外科的廣泛關(guān)注[1-3]。引起腦出血的危險(xiǎn)因素很多,其中高血壓在腦出血的發(fā)生過程中占的比重較大。國內(nèi)流行病學(xué)調(diào)查,腦出血發(fā)病率占腦卒中的17.1%~55.4%,明顯高于國外6.5%~19.6%的水平。急性期腦出血病死率為30%~40%,預(yù)后極差[4],是目前嚴(yán)重危害人類健康的常見疾病。在神經(jīng)外科,雖然人們對腦出血的治療在手術(shù)方法的選擇上趨于一致,但仍有一些爭議,包括手術(shù)時(shí)機(jī),手術(shù)方式的選擇等方面,而目前我國又在高血壓腦出血外科手術(shù)術(shù)式選擇方面缺乏詳細(xì)的規(guī)范,并缺乏較為全面的療效對比研究。目的探討高血壓腦出血手術(shù)方式的選擇及其治療效果。方法選擇解放軍第三醫(yī)院2012年11月-2013年10月204例腦出血手術(shù)患者(細(xì)化組),按照我們事先設(shè)計(jì)的6種腦出血手術(shù)方式的適應(yīng)癥,采取相應(yīng)的手術(shù)方式治療;另回顧分析2011年10月至2012年10月216例腦出血手術(shù)患者資料(傳統(tǒng)組),本組患者是經(jīng)驗(yàn)性地采取鉆孔血腫引流、微創(chuàng)開顱血腫清除、開顱血腫清除并去骨瓣減壓三種手術(shù)方式。對比兩組患者治療手術(shù)方式導(dǎo)致的差異。結(jié)果1、細(xì)化組與傳統(tǒng)組術(shù)前患者的性別、年齡、是否合并慢性病史,以及患者的意識狀態(tài)、出血部位、出血量兩組之間比較無統(tǒng)計(jì)學(xué)意義(P0.05)),說明細(xì)化組與傳統(tǒng)組患者術(shù)前狀況無差異。兩組患者均采用了標(biāo)準(zhǔn)的藥物治療,藥物治療和搶救治療方面無顯著差異。2、細(xì)化組鉆孔后再出血為24.68%,傳統(tǒng)組鉆孔后再出血為38.78%。c2=3.903,P0.05,兩組差異有統(tǒng)計(jì)學(xué)意義,細(xì)化組再出血率低于傳統(tǒng)組。3、去骨瓣減壓術(shù)后的死亡率比較,細(xì)化組為39.29%,傳統(tǒng)組為61.82%。c2=5.636,P0.05,兩組差異有統(tǒng)計(jì)學(xué)意義,細(xì)化組死亡率低于傳統(tǒng)組。4、兩組病例術(shù)后1個(gè)月死亡率比較,細(xì)化組死亡48例(23.53%),傳統(tǒng)組死亡78例(36.11%),兩者之間比較,c2=7.908,P0.05,差異有統(tǒng)計(jì)學(xué)意義,說明細(xì)化組治療死亡率明顯低于傳統(tǒng)組。5、術(shù)后3月根據(jù)改良Rankin量表(Modified Rankin Scale,m RS)在術(shù)后3月給予患者預(yù)后量表評定。術(shù)后1-3月細(xì)化組死亡4例,傳統(tǒng)組死亡2例。c2=3.378,P0.05,兩組預(yù)后差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:高血壓腦出血選擇恰當(dāng)?shù)氖中g(shù)方式,對腦出血患者的治療及愈后有顯著意義。
[Abstract]:Background Hypertension intracerebral hemorrhage (HICH) is one of the main diseases threatening human life at present. Especially in recent years, neurosurgery has paid close attention to [1-3] .There are many risk factors for intracerebral hemorrhage, in which hypertension accounts for a large proportion in the process of cerebral hemorrhage. The incidence of intracerebral hemorrhage (ICH) accounts for 17.1% of stroke, which is significantly higher than that of 6.555% in foreign countries. In neurosurgery, the mortality rate of ICH in acute stage is 30%, and the prognosis is very poor [4], which is a common disease that seriously endangers human health at present. Although the treatment of intracerebral hemorrhage tends to be consistent in the choice of surgical methods, there are still some controversies, including the timing of the operation, the choice of surgical methods and so on. At present, there is a lack of detailed rules on the selection of surgical procedures for hypertensive intracerebral hemorrhage in China. Objective to explore the choice of surgical methods for hypertensive intracerebral hemorrhage and its therapeutic effect. Methods 204 patients with intracerebral hemorrhage were selected from November 2012 to October 2013 in the third Hospital of PLA. Group A, according to the indications of the 6 types of intracerebral hemorrhage operations we designed beforehand, The data of 216 patients with intracerebral hemorrhage from October 2011 to October 2012 were retrospectively analyzed. Results 1. The gender, age, history of chronic disease and consciousness of the patients in the two groups were refined before operation. There was no significant difference in the bleeding location and bleeding volume between the two groups, indicating that there was no difference in preoperative status between the patients in the refined group and the traditional group. The patients in both groups were treated with standard drugs. There was no significant difference between drug therapy and rescue treatment. The rebleeding after drilling in the fine group was 24.68, and that in the traditional group was 38.78. C23903P0.05. There was significant difference between the two groups. The rate of rebleeding in the refined group was lower than that in the traditional group, and the mortality rate after decompression of bone flap was lower than that in the control group. 39.29 in the fine group and 61.82 in the traditional group. The difference between the two groups was statistically significant. The mortality rate in the refined group was lower than that in the traditional group. The mortality rate of the two groups was lower than that of the traditional group, and the mortality rate of the two groups was 1 month after operation. 48 cases died in the refined group and 78 cases in the traditional group. The difference between the two groups was statistically significant. The results showed that the mortality rate in the refined group was significantly lower than that in the traditional group. On March, the patients were evaluated with the prognosis scale according to the modified Rankin scale modified Rankin Scalem RSs. 4 patients died in the refined group in 1-3 months after operation. There was no significant difference in prognosis between the two groups. Conclusion: the choice of appropriate operation method for hypertensive intracerebral hemorrhage is significant for the treatment and recovery of cerebral hemorrhage patients.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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