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2464例高血压脑出血外科治疗多中心单盲研究 预览 被引量:411

The efficacy of three different approaches in treatment of hypertensive intracerebral hemorrhage: a multi-center single-blind study of 2464 patients
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摘要 目的对比高血压脑出血的传统开颅、CT引导血肿吸引和微骨窗入路三种手术方法,分析手术疗效.方法 2001年9月至2003年11月10日,国内135家医疗单位手术治疗2464例出血性脑卒中病例,完成3个月随访,采用多中心单盲研究方法比较不同手术方式疗效.结果 2464例中传统组639例,微骨窗组409例,吸引组1416例.1个月累计病死率19.3%,3个月累计病死率21.1%.术前Glasgow昏迷评分(GCS)≤8分的病人,术后3个月病死率是GCS≥8分的3.5倍;术后有并发症者,术后3个月病死率是无并发症者的4.4倍;丘脑出血术后3个月病死率是皮层出血病人的2.4倍.3个月的病死率传统组(24.6%)高于微骨窗组(17.6%)和吸引组(20.6%).三组间术后并发症,传统组(29.9%)与吸引组(24.8%)差异具有统计学意义(P=0.015).结论微骨窗入路及CT引导吸引术组治疗高血压脑出血的手术病死率与致残率,以及预后的改善情况,优于传统开颅组. Objective To compare the efficacy and indications of the 3 approaches: conventional open craniotomy (COC), computed- tomography guided aspiration (CTGA), and key-hole approach (KHA) in neurosurgical management for hypertensive intracerebral hemorrhage (HICH), Methods The clinical data of HICH 2464 patients,aged 14-75, operated on within 24 hours after stroke, with a Glasgow coma score ≥5, hospitalized in 135 hospitals all over the mainland of China, were collected and underwent single-blind study. Results Among the 2464 patients 639 underwent COC, 1416 underwent CTGA, and 409 were operated on via KHA. The overall mortality rates within one and three months after operation were 19.3% and 21.1% respectively. The mortality rate within 3 months after operation (M3m) of the patient with a GCS≤8 was 3.5 times as much as the M3m of the patients with a GCS≥8. The M3m of the patients with complications was 4.4 times as much as that of the patients without complications, The M3m of the patients with hemorrhage in thalamus was 2.4 times as much as that of the patients with cortical hemorrhage. The M3m of the COC group was 24.6%, higher than those of the KHA group ( 17.6% ) and CTGA group (20.6%). The postoperative complication rate of the COC group was 29.9%, significantly higher than that of the CTGA group (24. 8%, P = 0. 015 ). There were no significant differences in postoperative complication rate between the COC and KHA groups and between the CTGA and KHA groups ( both P 〉 0. 05). Conclusion KHA and CTGA are both better than COC in treatment of HICH with more favorable outcome and less postoperative mortality and morbidity.
作者 赵继宗 周定标 周良辅 王任直 王德江 王硕 袁葛 康帅 赵元立 季楠 叶迅 Zhao JiZong;Zhou DingBiao;Zhou LiangFu;Wang RenZhi;Wang DeJiang;Wang Shuo;Yuan Ge;Kang Shuai;Zhao YuanLi;Ji Nan;Xie Xun
出处 《中华医学杂志》 CAS CSCD 北大核心 2005年第32期 2238-2242,共5页 National Medical Journal of China
基金 国家科技攻关项目
关键词 颅内出血 高血压性 微创神经外科 颅骨切开术 CT引导吸引术 微骨窗入路 高血压脑出血 外科治疗 多中心 GLASGOW昏迷评分 Intracranial hemorrhage, hypertensive Minimally invasive neurosurgery Craniotomy Computed tomography guided aspiration Key-hole approach
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  • 1吴桂贤,吴兆苏.我国16省市脑卒中流行病学特征[J].中华医学杂志,1994,74(5):281-283. 被引量:82
  • 2Fernandes HM, Mendelow AD. Spontaneous intracerebral haemorrhage: a surgical dilemma. Br J Neurosurg, 1999, 13:389-394. 被引量:1
  • 3Fernandes HM, Gregson B, Siddique S, et al. Surgery in intracerebral hemorrhage. The uncertainty continues. Stroke, 2000,31:2511-2516. 被引量:1
  • 4Hankey GJ. Evacuation of intracerebral hematoma is likely to be beneficial-against. Stroke, 2003,34 : 1568-1569. Epub 2003 May 15. 被引量:1
  • 5Tan SH, Ng PY, Yeo TT, et al. Hypertensive basal ganglia hemorrhage: a prospective study comparing surgical and nonsurgical management. Surg Neurol, 2001,56:287-292 ; discussion 292-293. 被引量:1
  • 6Hankey GJ, Hon C. Surgery for primary intracerebral hemorrhage: is it safe and effective? A systematic review of case series and randomized trials. Stroke, 1997,28:2126-2132. 被引量:1
  • 7Broderiek JP, Adams HP Jr, Barsan W, et al. Guidelines for the management of spontaneous intracerebral hemorrhage : a statement for healtheare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke, 1999,30:905-915. 被引量:1
  • 8Minematsu K. Evacuation of intracerebral hematoma is likely to be beneficial. Stroke, 2003,34 : 1567-1568. Epub 2003 May 15. 被引量:1
  • 9Grotta JC. Acute stroke therapy in the millennium: consummating the marriage between the laboratory and the bedside: the Feinberg lecture. Stroke,1999,30 : 1722-1728. 被引量:1
  • 10陈衔城,杨涵铭.高血压脑出血的内外科治疗疗效比较[J].上海医科大学学报,1992,19(3):237-240. 被引量:18

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