目的:研究微创穿刺联合开颅减压治疗高血压脑出血致脑疝患者的疗效及预后.方法:选择2017年6月至2018年2月于广东三九脑科医院就诊的50例高血压脑出血致脑疝患者,按照随机数字法分为对照组和观察组,各25例.对照组行常规开颅血肿清除术及去骨瓣减压术,观察组采取微创穿刺引流联合开颅减压的术式,比较两组患者临床疗效、巴氏指数(BI)评分、格拉斯哥预后量表(GOS)评分及并发症发生率.结果:观察组的总有效率为96.00％,显著高于对照组的72.00％,差异具有统计学意义(P＜0.05);观察组术后3个月BI评分高于对照组,差异具有统计学意义(P＜0.05);观察组GOS评分Ⅳ、Ⅴ级人数占比高于对照组,差异具有统计学意义(P＜0.05).结论:微创穿刺联合开颅减压治疗高血压脑出血致脑疝疗效较好,明显改善患者的预后.

Objective To investigate the impact flat deformity of the cerebral cortex induced by congenital hydrocephalus on motor functioning and cognition.Methods Tomography was used to confirm the presence of flat cortex deformity in three congenital hydrocephalus patients ranging in age from 20 to 33.Their motor control,balance,cognition and ability in the activities of daily living (ADL) were evaluated using the Fugl-Meyer assessment (FMA),the Berg balance scale (BBS),the mini-mental state examination (MMSE) and the modified Barthel index (MBI).Speech dysfunction was judged on the basis of clinical communication.The patients were scanned using a 64-slice spiral CT and size-of-ventricle indices were calculated.Results All 3 patients underwent ventrideperitoneal shunt.Their FMA scores were 75.5,83 and 100,with BBS scores of 4,24 and 56,MMSE scores of 14,23 and 26,and the MBIs of 40,90 and 100.CT images showed obvious ventricle enlargement and a thinner cortex layer in all three,with the thinnest part 0.18 cm,0.22 cm and 0.57 cm.Their ventricle indexes were 303％,288％ and 192％,respectively.Conclusion Although there is no systematic rehabilitation therapy for such patients,their motor,cognition and speech functioning were good,indicating the great potential for plasticity of the human brain.