Surgical Outcome of Hypertensive Putaminal Hemorrghage in Patients Older Than 65 Years

老年人高血壓性被殼出血的外科治療

林志隆(Chin-Lung Lin) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 14卷5期 (1998/05) Pp. 280-285

https://doi.org/10.6452/KJMS.199805.0280

摘要

對於高血壓性被殼出血的治療仍無定論，尤其是大於65歲以上的老年人。本文的目的乃在探討外科治療在死亡率及病人日常生活活動 ( ADL ）的預後。共有 32位病人接受手術治療去除血腫，半年後追蹤其日常生活活動。病人以Glasgow 昏迷指數中的眼睛及運動反應來評估，當成 ICH 等級。而血腫大小以電腦斷層上血腫的最大長乘以最大寬再乘以最大厚度除以2來表示。ICH等級與血腫大小和預後有密切相關，手術後病人回復到ADL 1及2者，在ICH第一級為40 %，第二級為 16.7 % ，第三級為 20 % ，第四級為 0 ％。死亡率在 ICH 第一級為0 %，第二級為16.7 %，第三級為40 %，第四級為62.5 %。血腫大小在60毫升以上者為77.8 % , 60毫升以下者為39.1％。由我們的有限經驗得知，大於65歲以上的老年人患有高血壓性被殼出血者，外科治療只考慮在血腫大小在20至 60毫升之間，即使在如此的適應症下，仍然有高的死亡率，也只有四分之一的病人術後回復到ADL 1及2者。

並列摘要

There is no consensus of opinion on the treatment of hypertensive putaminal hemorrhage(HPH), especially in patients older than 65 years. The purpose of this study was to study the surgical outcome of HPH in patients older than 65 years while considering mortality and activity of daily life. Among eighty-three patients aged 65 or older with HPH, fifty-one patients received only medical treatment and 32 were operated upon to remove the hematoma. Each patient was measured by the intracerebral hemorrhage-intracranial hemorrhage grading scale (ICH Grade) which used the sum of eye opening and motor response scores derived from Glasgow Coma Scale. The cubic content of the HPH was calculated from measurement of maximum width (X), length (Y) and height (Z), and the hematoma volume taken as 1/2 that volume (X . Y . Z/2). The acute mortality in surgically treated group was 40.6% and three patients died during the follow-up period from one to six months after the operation. Determinant for the prognosis was the ICH grade and the volume of the hematoma. Patients who returned to ADL 1 and 2 (good recovery) after surgical treatment were 40.0% in ICH Grade I, 16.7% In ICH Grade II , and 20.0% in ICH Grade ifi . Among those patients who were in ICH Grade IV, none had good recovery. The acute mortality was zero in ICH Grade I, 16.7% in ICH Grade II , 40.0% in ICH Grade ifi, and 62.5% in ICH Grade IV. The crucial size was 60 ml with a mortality of 77.8% for hematomas larger and 39.1% for hematomas smaller than that. From our lim ited experience, we learned that operation in elderly patients with HPH was considered only in patients with hematomas between 20 to 60 ml, with a high operative mortality and only one-fourth having a good recovery postoperatively.

並列關鍵字

putamen ； elderly patients ； surgical outcome