超早期显微手术联合脑室外引流治疗高血压性小脑出血

Clinical effect of ultra-early microsurgery combined with external ventricular drainage in treatment of hypertensive cerebellar hemorrhageWANG Peng, LIU Fu-Zheng, YIN Shang-Jiong, LIU Li-NaDepartment of Neurosurgery, The Hospital of 81st Group Army PLA, Zhangjiakou, Hebei 075000, China

摘要:

目的 探讨应用无牵拉脉冲式冲水技术超早期显微手术联合脑室外引流治疗高血压性小脑出血的临床效果。方法 回顾性分析2014年6月—2020年6月该院收治的63例高血压性小脑出血重症患者的临床资料，并应用无牵拉脉冲式冲水技术超早期显微手术清除血肿并联合脑室外引流及颅内压监测为治疗方案，采用格拉斯哥昏迷量表（GOS）评分评价预后。结果 手术时间（178±20） min，术中出血量（85±20） mL，血肿清除率（90±5）%，再出血2例（3.2%），术后1个月内死亡4例(6.3%)。术后3个月，按GOS评分，恢复良好30例(47.6%)，中度残疾18例(28.6%)，重度残疾5例(7.9%)，植物生存4例(6.5%)，死亡6例(9.5%)，脑积水发生7例(11.1%)。结论 应用无牵拉脉冲式冲水技术超早期显微手术清除血肿联合脑室外引流治疗高血压性小脑出血可迅速解除梗阻性脑积水及脑干受压，且创伤小、血肿清除率高，同时行颅内压监测，可改善预后，是治疗高血压小脑出血的有效方式。国际神经病学神经外科学杂志, 2021, 48(1): 13-16］

Abstract:

Objective To investigate the clinical effect of tension-free pulse flushing ultra-early microsurgery combined with external ventricular drainage in the treatment of hypertensive cerebellar hemorrhage.Methods A retrospective analysis was performed for the clinical data of 63 patients with severe hypertensive cerebellar hemorrhage who were admitted from June 2014 to June 2020， and all patients were treated with tension-free pulse flushing ultra-early microsurgery for hematoma clearance in combination with external ventricular drainage and intracranial pressure monitoring. Glasgow Outcome Scale （GOS） was used to evaluate prognosis.Results All these patients had an operation duration of 178±20 min， an intraoperative blood loss of 85±20 mL， and a hematoma clearance rate of 90%±5%. Rebleeding was observed in 2 patients （3.2%）， and 4 patients （6.3%） died within 1 month after surgery. GOS score showed that at 3 months after surgery， 30 patients （47.6%） achieved good recovery， 18 （28.6%） had moderate disability， 5 （7.9%） had severe disability， 4 （6.5%） had vegetative survival， and 6 （9.5%） died. Of all patients， 7 （11.1%） experienced hydrocephalus.Conclusions In the treatment of hypertensive cerebellar hemorrhage， tension-free pulse flushing ultra-early microsurgery for hematoma clearance combined with external ventricular drainage can quickly relieve obstructive hydrocephalus and brain stem compression， with little trauma and high hematoma clearance rate， and intracranial pressure monitoring can be performed to improve prognosis. Therefore， it is an effective method for the treatment of hypertensive cerebellar hemorrhage.Journal of International Neurology and Neurosurgery, 2021, 48(1): 13-16］