高血压脑干出血破入第四脑室患者的手术治疗分析

摘要

Objective To investigate the clinical characteristic, method and therapeutic effect of hypertensive brainstem hemorrhage into the fourth ventricle. Methods 31 patients with hypertensive brainstem and fourth ventricle hematoma were retrospectively analyzed. Results 17 of them underwent puncture of side ventricles of the brain, mortality rate was 29.41%. 14 of them underwent surgery, mortality rate was 71.42%. Prognosis was judged by GOS standards, 15 patients were death, 3 severe disability, 4 moderate disability and 5 good recovery. Eliminate influence of bias, there was no statistically significant differences between the two therapeutic methods. 4 Patients who underwent conservative treatment meanwhile were all dead, the mortality rate 100%. Statistical difference exists between mortality of surgical treatment patients and medical treatment patients. Conclusion According to the patients, proper evacuation of brainstem and fourth ventricle hematoma can improve patients'outcome.%目的:探讨高血压脑干出血破入第四脑室患者的病例特点、手术方式及对预后的影响.方法:回顾性分析2008年1月～2010年12月我科手术治疗31例高血压脑干出血破入第四脑室病例的临床和影像学资料,探讨其临床特点和手术方式对患者预后的影响.结果:31例高血压脑干出血破入第四脑室患者中17例行侧脑室穿刺引流术,死亡率29.41％.14例行枕下后正中入路脑干血肿清除术,死亡率为71.42％.对所有病例按GOS标准进行预后判定,其中1级(死亡)15例,3级(重残)3例,4级(中残)7例,5级(恢复良好)6例.手术方式的选择存在样本选择偏差,去除偏差后两种手术对患者预后影响无统计学差异.同期4例行保守治疗患者均死亡,死亡率100％,与手术组患者死亡率存在统计学差异(P＜0.01).结论:对于高血压脑干出血破入脑室的患者,建议根据出血量、病情及时选择手术方式进行治疗,有利于提高患者生存率,改善预后.