本文選題：基底節(jié)區(qū) + 高血壓��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的比較經(jīng)顳葉大骨瓣手術(shù)、微創(chuàng)血腫碎吸術(shù)及顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱術(shù)三種術(shù)式治療高血壓基底節(jié)區(qū)出血的臨床療效。方法選擇安陽市第三人民醫(yī)院,2011年4月至2015年4月期間,接受手術(shù)治療患者的臨床資料,經(jīng)顳葉大骨瓣手術(shù)38例,微創(chuàng)血腫碎吸術(shù)63例,顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱術(shù)59例。三組病例資料均在手術(shù)前按患者的一般特征(性別、年齡)、GCS昏迷評(píng)分、出血量、來院時(shí)血壓、術(shù)前準(zhǔn)備時(shí)間進(jìn)行均衡性分析,3個(gè)月完成隨訪,通過分析GOS預(yù)后評(píng)分、病死率,評(píng)價(jià)療效。結(jié)果1.一般特征(性別、年齡)、術(shù)前GCS評(píng)分、術(shù)前準(zhǔn)備時(shí)間、出血量(多田公式計(jì)算)、來院時(shí)血壓無統(tǒng)計(jì)學(xué)差異(P0.05)。2.3個(gè)月術(shù)后隨訪GOS評(píng)分,經(jīng)顳葉大骨瓣手術(shù)組、微創(chuàng)血腫碎吸組與顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組預(yù)后有效率,有統(tǒng)計(jì)學(xué)差異(P0.05)),表明顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組、微創(chuàng)血腫碎吸術(shù)組預(yù)后優(yōu)于經(jīng)顳葉大骨瓣手術(shù)；但顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組和微創(chuàng)血腫碎吸術(shù)組預(yù)后有效率比較無統(tǒng)計(jì)學(xué)差異(P0.05)。3.總病死例數(shù)33例(20.6%),顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組、微創(chuàng)血腫碎吸術(shù)組與經(jīng)顳葉大骨瓣手術(shù)組病死率進(jìn)一步比較,存在統(tǒng)計(jì)學(xué)差異(P0.05)；顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組與微創(chuàng)血腫碎吸術(shù)組病死率比較,不存在統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)果表明：顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組、微創(chuàng)血腫碎吸術(shù)組病死率均優(yōu)于經(jīng)顳葉大骨瓣手術(shù)組；但小骨窗經(jīng)側(cè)裂開顱組較微創(chuàng)血腫碎吸術(shù)無明顯優(yōu)勢(shì)。4.三組中不良預(yù)后病例總數(shù)70例,其中35例出血量80 ml,占50.0%；33例GCS評(píng)分8分,占47.1%。出血量在31～50 ml、51～80 ml,GCS評(píng)分9～12分、6～8分的,不良預(yù)后率三組間比較存在統(tǒng)計(jì)學(xué)差異(P0.05)；出血量超過80 ml,GCS評(píng)分3～5分的預(yù)后不良率三組間比較不存在統(tǒng)計(jì)學(xué)差異(P0.05),提示出血量超過80 ml,GCS評(píng)分3～5分的患者,手術(shù)方式的選擇對(duì)療效并無明顯差別。結(jié)論1.顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱組與微創(chuàng)血腫碎吸術(shù)組預(yù)后優(yōu)于經(jīng)顳葉大骨瓣手術(shù)組；2.出血量80 ml,GCS評(píng)分8分,顯微鏡輔助小骨窗經(jīng)側(cè)裂開顱對(duì)于患者預(yù)后存在優(yōu)勢(shì)；3.大面積腦出血患者,經(jīng)顳葉大骨瓣手術(shù)在臨床的作用不可取代；4.微創(chuàng)血腫碎吸術(shù)創(chuàng)傷小,簡(jiǎn)便易操作,出血量較少患者能獲得較好的預(yù)后。
[Abstract]:Objective to compare the clinical effects of large temporal lobe bone flap surgery, minimally invasive hematoma crushing and microscopically assisted small bone window craniotomy in the treatment of hypertensive basal ganglia hemorrhage.Methods from April 2011 to April 2015, the clinical data of 38 patients with large temporal lobe bone flap, 63 patients with minimally invasive hematoma and 59 patients with microscopically assisted small bone window craniotomy were selected from the third people's Hospital of Anyang City from April 2011 to April 2015.The data of the three groups were analyzed according to the general characteristics of the patients before operation (sex, age, GCS coma score, blood loss, blood pressure at hospital, preoperative preparation time, 3 months follow-up, GOS prognosis score, mortality, etc.)To evaluate the curative effect.Result 1.General characteristics (sex, age, preoperative GCS score, preoperative preparation time, bleeding volume (Duotian formula), no significant difference in blood pressure at hospital (P 0.05). 2. 3 months follow-up GOS score, transtemporal lobe large bone flap operation group.The effective rate of prognosis between the minimally invasive hematoma aspiration group and the microscopically assisted small bone window open craniotomy group was significantly different (P 0.05), which indicated that the prognosis of the microinvasive hematoma crushing group was better than that of the large temporal lobe bone flap operation.However, there was no significant difference in the effective rate of prognosis between the microscopically assisted small bone window craniotomy group and the minimally invasive hematoma crushing group (P0.05. 3).The total death rate of 33 cases was 20. 6%. The mortality of microscopically assisted small bone window craniotomy group, minimally invasive hematoma fragmentation group and transtemporal lobe large bone flap group was further compared.There was statistical difference (P 0.05) and there was no significant difference in mortality between the microscopically assisted small bone window craniotomy group and the minimally invasive hematoma aspiration group (P 0.05).The results showed that the mortality of the microscopically assisted small bone window craniotomy group was better than that of the transtemporal lobe large bone flap group, but there was no significant advantage in the small bone window craniotomy group compared with the minimally invasive hematoma fracturing group.There were 70 cases of poor prognosis in the three groups, of which 35 cases had blood loss of 80 ml, accounting for 50.0% and 33 cases with GCS score of 8 points, accounting for 47.1%.The GCS score was 9 ~ 12 and 6 ~ 8, respectively.There was no significant difference in poor prognosis rate among the three groups (P 0.05), and there was no significant difference in the rate of poor prognosis among the three groups with bleeding over 80 ml / g GCS score of 3 ~ 5 points, which suggested that the patients whose bleeding volume exceeded 80 ml / g GCS score were 3 ~ 5 points.There was no significant difference in the outcome of the operation.Conclusion 1.The prognosis of microscopically assisted small bone window craniotomy group and minimally invasive hematoma shredding group was better than that of the large temporal lobe bone flap group.The 80 ml / g GCS score of 80 ml / L and the microscopically assisted craniotomy with small bone window had an advantage in the prognosis of the patients.In patients with massive intracerebral hemorrhage, the clinical effect of large temporal lobe bone flap can not be replaced by 4. 4%.The patients with minimally invasive hematoma crushing and aspiration can obtain better prognosis with small trauma, simple and easy operation and less bleeding.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1

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