【摘要】 目的 探讨影响钻颅血肿引流治疗重症高血压脑出血效果的因素。方法 根据CT定位，钻颅，直接穿刺血肿，抽吸加纤溶药物后引流，共48例。分析手术时机、出血量、意识状态、年龄、并发症与疗效的关系。结果 钻颅穿刺脑内血肿，抽吸加引流治疗，效果不佳，总有效率仅29.2%。但发病7h后手术较7h内手术，有效率明显提高，另外血肿的大小，术前的意识障碍程度及有无严重并发症等因素对治疗效果影响较大。血肿越大治疗效果越差，血肿<50ml有效率33.3%。血肿>50ml有效率14.3%。结论 本方法简便、安全、对脑组织创伤小，再出血机会少，适应证较广泛。随着手术方法的改进和新型纤溶药物的应用，临床效果有望进一步提高。

    【关键词】 高血压脑出血；穿刺；钻颅；引流

    Hypertensive intracerebral hemorrhage treated by drilling and draining

    LIU Bao-ji,TAO Zeng-yue.Surgical Department,The Branch of the First People’s Hospital of Shanghai,Shanghai 200081,China

    【Abstract】 Objective To explore the effective factors of the advanced hypertensive intracerebral hemorrhage (HICH) treated by drilling and draining.Methods 48 cases were positioned by CT scanning,drilled,punctured directly,aspirated and drained after injecting the fibrinolysis.The effective factors were analyzed,including:the operative time, the heamatoma volume,the conscious state,age, and the complications.Results The effective rate is only 29.2%,the cases operated after 7 hours from the onset had the better result than that in 7 hours and so had the case with less heamatoma volume,lower consciousness,less complication and the younger age.Conclusion Drilling and draining is a simple and safe treatment,less injuries to the brain,less rebleeding, more generally indicated,and it can be improved by the advancing operative technique and newly developing fibrinolysis medicine. ......