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題名 | 高血壓性小腦出血手術治療的經驗﹣﹣著重預後因素的研究 |
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作者姓名(中文) | 許昭智; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 20:3 1987.05[民76.05] |
頁次 | 頁229-237 |
分類號 | 416.291 |
關鍵詞 | 高血壓性小腦出血; 手術治療; |
語文 | 中文(Chinese) |
中文摘要 | 由1979年1月至1984年12月,六年間,榮民總醫院共有76例白發性小腦出血的病人住院,其中47例為高血壓性引起,所有的病例皆經過頭部電腦斷層檢查證實;本文將27例接受手術治療的病人(其血腫皆大於或等於3公分),在手術前的意識狀態分為三組,第一組GCS≦7有13例,第二組GCS為8-12有8例,第三組GCS≧13有6例;手術結果以第一組GCS≦7為最差,7例死亡,死亡率為54%(7/13),另六例手術後六個月祇恢復到McKissock手術後功能恢復表III/IV等級而已;第二組GCS為8-12,有2例死亡,死亡率為25%(2/8),祇有一例手術後功能恢復到I/II等級,其餘5例仍在III/IV等級;第三組GCS≧13,手術預後最好,無死亡率,且6例中有5例(83%)恢復到I/II等級。併發症有5例,積極治療後只有一例死亡(第二組);總共的死亡例為33% (9/27)。 本系列分析研究的結果歸納如下: 1.手術前的意識狀龍為決定手術預後最重要的因素。 2.其次,血腫是否破入腦室、是否伴有急性水腦症、及手術前病程演變的緩急皆亦典預後有直接的關係。 3.手術病人的年齡、血腫本身的大小卻與預後沒有直接的關係。 |
英文摘要 | Twenty-seven cases of hypertensive cerebellar hemorrhage were operated upon during the six-year period from 1979 to 1984. In all cases diagnosis was made by brain CT scan. The cases were divided into 3 groups according to the preoperative Glasgow Coma Scale (GCS) as follows: Group 1: 13 cases with GCS under or equal to 7. Group 2: 8 cases with GCS 8-12. Group 3: 6 cases with GCS over or equal to 13. The outcome was evaluated with the postoperative functional recovery scale of McKissock et al. The poorest results occurred in Group 1 with 7 deaths, and 6 cases at Gr III/IV. Group 3 had the best results with no mortality, and 5 cases of survival at the Gr I/II level. In group 2 there were 2 deaths, 5 cases at Gr III/IV and 1 case at Gr I/II. Five patients had complications: one died of rebleeding and the remaining four improved and were in fair condition after treatment. The over-all mortality rate was 33% (9 out of 27). The mortality rate was 54% in patients with GCS under or equal to 7 and significantly decreased to 14% (P=0.0461<0.05, Fisher Exact test) in patients with GCS over or equal to 8. The preoperative factors influencing the prognosis in this study are summarized as follows: 1. The preoperative level of consciousness was the most important factor in this study, with the mortality rate inversely proportionate to the GCS score. 2. Hemorrhage into the 4th ventricle, acute hydrocephalus, and rapid onset of the ciinical course, in that order, were the other poor prognostic factors next in importance to the low GCS score. 3. The age and size of the hematoma itself were not related to predictive factor in this series. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。