自发性幕上脑出血：手术对昏迷患者有益吗？
Spontaneous supratentorial intracerebral hemorrhage: Does surgery benefit comatose patients?
作者信息
Yilmaz Cem, Kabatas Serdar, Gulsen Salih, Cansever Tufan, Gurkanlar Doga, Caner Hakan, Altinors Nur
机构信息
Department of Neurosurgery, Baskent University, Ankara, Turkey.
出版信息
Ann Indian Acad Neurol. 2010 Jul;13(3):184-7. doi: 10.4103/0972-2327.70881.
INTRODUCTION
Treatment of spontaneous supratentorial intracerebral hemorrhage (SICH) is still controversial. We therefore analyzed the comatose patients diagnosed as having spontaneous SICH and treated by surgery.
MATERIALS AND METHODS
We retrospectively analyzed the collected data of 25 comatose patients with initial Glasgow Coma Scale (GCS) ≤ 8 diagnosed as having spontaneous SICH and they had been treated by surgical evacuation between 1996 and 2008. The outcome was assessed using Glasgow outcome scale (GOS). The side and location of the hematoma and ventricular extension of the hematoma were recorded. The hematoma volume was graded as mild (<30 cc), moderate (30-60 cc) and massive (>60 cc).
RESULTS
Age of the patients ranged from 25 to 78 years (mean: 59.6 ± 15.14 years). Among the 25 patients studied, 11 (44%) were females and 14 (56%) were males. GCS before surgery was <5 in 8 (32%) patients and between 5 and 8 in 17 (68%) patients. The hematoma volume was less than 30 cc in 2 patients, between 30 and 60 cc in 9 patients and more than 60 cc in 14 patients. Fourteen of the patients had no ventricular connection and 11 of the hematomas were connected to ventricle. All the 25 patients were treated with craniotomy and evacuation of the hematoma was done within an average of 2 hours on admission to the emergency department. Postoperatively, no rebleeding occurred in our patients. The most important complication was infection in 14 of the patients. The mortality of our surgical series was 56%. GCS before surgery was one of the strongest factors affecting outcome GCS (oGCS) (P = 0.017). Income GCS (iGCS), however, did not affect GOS (P = 0.64). The volume of the hematoma also affected the outcome (P = 0.037). Ventricular extension of the hematoma did affect the oGCS and GOS (P = 0.002), but not the iGCS of the patients (P = 0.139).
CONCLUSION
Our data suggest that being surgically oriented is very important to achieve successful outcomes in a select group of patients with SICH.
引言
自发性幕上脑出血（SICH）的治疗仍存在争议。因此，我们分析了诊断为自发性SICH并接受手术治疗的昏迷患者。
材料与方法
我们回顾性分析了1996年至2008年间收集的25例初始格拉斯哥昏迷量表（GCS）≤8分、诊断为自发性SICH且接受手术清除血肿治疗的昏迷患者的数据。使用格拉斯哥预后量表（GOS）评估预后。记录血肿的部位和位置以及血肿向脑室的扩展情况。将血肿体积分为轻度（<30立方厘米）、中度（30 - 60立方厘米）和重度（>60立方厘米）。
结果
患者年龄在25至78岁之间（平均：59.6±15.14岁）。在研究的25例患者中，11例（44%）为女性，14例（56%）为男性。术前GCS<5分的患者有8例（32%），5至8分的患者有17例（68%）。血肿体积小于30立方厘米的患者有2例，30至60立方厘米的患者有9例，大于60立方厘米的患者有14例。14例患者血肿与脑室无连通，11例血肿与脑室连通。所有25例患者均接受开颅手术，平均在急诊科入院后2小时内完成血肿清除。术后，我们的患者未发生再出血。最重要的并发症是14例患者发生感染。我们手术系列的死亡率为56%。术前GCS是影响预后GCS（oGCS）的最强因素之一（P = 0.017）。然而，入院时GCS（iGCS）并不影响GOS（P = 0.64）。血肿体积也影响预后（P = 0.037）。血肿向脑室的扩展确实影响oGCS和GOS（P = 0.002），但不影响患者的iGCS（P = 0.139）。
结论
我们的数据表明，对于一组特定的SICH患者，采取手术治疗对于获得成功的预后非常重要。
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