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Minimally invasive treatment of hypertensive cerebral hemorrhage needle aspiration experience of 200 cases

, CT assisted stereotactic hematoma evacuation widely used in clinical surgery, the trauma, efficacy, improved cure rate was increased, but the operation is complex, with a positioning framework to be reviewed after diagnosis CT, determine the target (hematoma center) after back surgery Room biopsy, time-consuming long, complicated process is not conducive to hypertensive cerebral hemorrhage early to remove the hematoma 【1l. 3.1 The timing of surgery in the past studies have shown that most hypertensive cerebral hemorrhage to stop bleeding after 20 ~ 30rain and the formation of hematoma, but some high blood pressure or antihypertensive treatment blood pressure greater sustainable bleeding 3 ~ 5h,[link widoczny dla zalogowanych], 6h of generally bleeding stopped completely. 6h after the edema around the hematoma and gradually intensified oppression hematoma longer irreversible damage to brain tissue around the more serious,[link widoczny dla zalogowanych], death, disability rate is higher. If bleeding in the brain within the ultra-7h early to remove the hematoma can quickly relieve brain pressure, so that secondary brain edema, cerebral hypoxia greatly reduced, thereby effectively protect neurological function and improve quality of life. 6h remove the hematoma within the high incidence of recurrent bleeding, it should be after 6h in the cerebral hemorrhage, but if the hematoma is greater than 60ml, easily lead to secondary brain stem damage, hematoma aspiration in time of emergency decompression, to facilitate the brain functional recovery. The group of 23 patients treated within 6h, hematoma volume greater than 60ml, of which 2 cases of hematoma volume in 80mI, functional recovery is better than delayed operation cases. 3.2 Prevention of complications of infection and postoperative complications mainly rebleeding. L There were no cases of infection, is the result of strict aseptic technique. 6h hypertensive cerebral hemorrhage in bleeding in some not yet fully stop 131, the possibility of re-bleeding during major surgery. 6h of the onset of 32 cases within the surgery, and then bleeding in 8 cases. Rebleeding after hematoma cavity is a common complication rate was 4% ~ 16% t4J. The group had eight cases, 4%, the occurrence rate is low. I believe that the key to prevention of postoperative bleeding measures are the following: ① 6h after surgery, but a huge amount of hematoma who required emergency surgical decompression exceptions. ② blood pressure should be monitored before and after surgery, control of blood pressure in the 12 ~ 24,8 ~ 14kPa, high blood pressure before surgery may be blood pressure, stability, and then puncture. ③ hematoma puncture in the center target. (Barrier) is not too much force when pumping, pumping speed of 2 ~ 3ml/min appropriate. ⑤ vampire first pumping about 40% to 50%, since the rest of hemostasis due to the role, but the incidence of aspiration 24h after surgery 70%. ⑥ appropriate use of liquefied hematoma agent: I understand the treatment of urokinase, heparin hemolytic effect is reliable. Urokinase is the best hematoma dissolving drug,[link widoczny dla zalogowanych], its non-antigenicity and toxicity, small doses can be achieved within a short time break down blood clots in the role; heparin liquefied hematoma, with similar effects, their combination significantly enhanced the role, but heparin can induce clotting mechanism to urokinase-based, as far as possible without heparin. ⑦ per 10ml of blood to be pumped interval of 5-10min, waiting for the slow rebound in brain tissue, hematoma cavity to avoid excessive pressure drop in a short time. ⑧ CT follow-up after the individual is still bleeding hematoma aspiration, or a fresh blood leads to who may, by needle injection of drugs such as thrombin or reptilase bleeding, to be stable after the injection of urokinase. 3.3 ① advantages of minimally invasive treatment of intracranial hematoma safe, effective and beneficial to senior citizens, accompanied by other serious diseases and the treatment of critically ill patients. ② puncture trauma itself, is conducive to functional recovery. ③ simple, low cost, without limitation occasions and equipment, especially suitable for primary hospital. ④ fast as hematoma, the patient awake early, reducing the lung infection,[link widoczny dla zalogowanych], gastrointestinal bleeding, urinary tract infection and other complications, reducing mortality.
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