【摘要】：目的：對(duì)基底節(jié)區(qū)高血壓腦出血病例的臨床治療和隨訪(fǎng)研究,探討基底節(jié)區(qū)高血壓腦出血(40-70ml)患者不同治療方法的臨床療效。方法：通過(guò)回顧分析廣西醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)外科及神經(jīng)內(nèi)科2012年6月-2014年10月收治的確診為基底節(jié)區(qū)高血壓腦出血,年齡在40-70歲,出血量在40-70ml,無(wú)大量出血破入腦室、無(wú)嚴(yán)重器質(zhì)性病變及凝血功能異常、腦疝病人的臨床表現(xiàn)、影像學(xué)資料及治療方法。比較兩組患者的治療前、治療后1天、治療后一周及治療后6個(gè)月末血腫量變化、意識(shí)恢復(fù)、死亡率及治療后6個(gè)月療效等情況,分析2組療效。結(jié)果：研究組(手術(shù)治療組)病人57例,對(duì)照組(保守治療組)病人39例。兩組入院時(shí)情況(年齡、出血量、GCS評(píng)分),無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。1、起病1周后,研究組患者GCS評(píng)分顯著高于對(duì)照組患者(P0.05)。證實(shí)手術(shù)治療基底節(jié)區(qū)高血壓腦出血在意識(shí)恢復(fù)方面強(qiáng)于保守治療。2、外科術(shù)后1周和保守治療后1周,研究組較對(duì)照組患者血腫量明顯減少,兩組患者的血腫量變化差異顯著(P0.05)。表明手術(shù)治療基底節(jié)區(qū)高血壓腦出血在清除血腫方面強(qiáng)于保守治療。3、研究組死亡9例,死亡率15.79%,對(duì)照組死亡17例,死亡率43.59%。兩組間差異顯著(P0.05),表明手術(shù)治療對(duì)比保守治療可顯著降低死亡率。4、研究組預(yù)后良好35例(60.34%),對(duì)照組預(yù)后良好14例(35.90%)。兩組間差異顯著(P0.05)。表明研究組預(yù)后優(yōu)于對(duì)照組。結(jié)論：行開(kāi)顱經(jīng)外側(cè)裂顯微鏡下血腫清除術(shù)治療出血量在40-70m1,年齡在40-70歲之間的基底節(jié)區(qū)高血壓腦出血患者的療效可靠,治療后患者血腫量變化、意識(shí)恢復(fù)、死亡率及6個(gè)月療效等均優(yōu)于保守治療。
[Abstract]:Objective: to investigate the clinical treatment and follow-up of hypertensive intracerebral hemorrhage (40-70ml) in basal ganglia region. Methods: the diagnosis of hypertensive intracerebral hemorrhage in basal ganglia was analyzed retrospectively in the Department of Neurosurgery and Neurology of the first affiliated Hospital of Guangxi Medical University from June 2012 to October 2014. The age was 40-70 years old and the amount of bleeding was 40-70 ml. No severe organic lesions, coagulation abnormalities, brain hernia, clinical manifestations, imaging data and treatment methods. The changes of hematoma volume, consciousness recovery, mortality and curative effect were compared between the two groups before, 1 day, 1 week and 6 months after treatment. Results: there were 57 cases in the study group and 39 cases in the control group. There was no significant difference between the two groups on admission (age, bleeding volume and GCS score) (P0.05). One week after onset, the GCS score of the patients in the study group was significantly higher than that in the control group (P0.05). The results showed that the recovery of consciousness of hypertensive intracerebral hemorrhage in basal ganglia region was stronger than that in conservative treatment. 1 week after surgery and 1 week after conservative treatment, the hematoma volume in the study group was significantly lower than that in the control group, and the difference between the two groups was significant (P0.05). The results showed that the operative treatment of hypertensive intracerebral hemorrhage in basal ganglia area was stronger than that in conservative treatment. The death rate was 15.79 in the study group and 17 in the control group. The mortality rate was 43.59 in the study group. The difference between the two groups was significant (P0.05), which indicated that the operative treatment compared with conservative treatment could significantly reduce the mortality rate of .4. the prognosis of 35 cases (60.34%) in the study group and 14 cases (35.90%) in the control group were good. There was significant difference between the two groups (P0.05). The prognosis of the study group was better than that of the control group. Conclusion: the treatment of hematoma clearance under the microscope through craniotomy is reliable in patients with hypertensive intracerebral hemorrhage in basal ganglia between 40 and 70 years old. After treatment, the hematoma volume changes and consciousness recovers in patients with hypertensive intracerebral hemorrhage in basal ganglia. The mortality and 6 months curative effect were superior to conservative treatment.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R651.1

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