Abstract: Objective To compare the curative effects of neurosurgical and neurological treatment on severe basal ganglia hemorrhage, and to propose the operation indications. Methods One hundred cases according with JinGu level Ⅳ b and V were treated with operation or non-operation. All cases were accorded with the standard of hypertensive severe basal ganglion and thalamus hematoma level in CT imaging. SPSS 10.0 software was used for statistical analysis. Results The total case-fatality rate in operation group and non-operation group was 62%(62/100) and 92%(92/100), respectively (χ2 = 23.744, P = 0.000). The total case-fatality rate of Ⅲ -Ⅳ level in CT imaging group and Ⅰ -Ⅱ level in CT imaging group was 84.21% (32/38) and 48.39% (30/62), respectively (P = 0.000). The total case-fatality rate in craniotomy operation group and non-craniotomy operation group was 54.41% (37/68) and 78.13% (25/32), respectively (χ2 = 7.920, P = 0.048). Conclusion Patients with JinGu level Ⅳ b of severe basal ganglia hemorrhage should be operated actively. Patients in JinGu level Ⅴ group should be operated cautiously referred with the following factors: age (< 60 years old); brain hernia occurrence time (onset time > 12 h); level in CT imaging (Ⅰ -Ⅱ level); systemic disease [no major visceral (heart, lung, liver, kidney) disease and diabetes].

Key words: Intracranial hemorrhage, hypertensive, Basal ganglia, Hematoma, Drug therapy, Neurosurgical procedures

摘要： 目的 探讨极重型基底节脑出血患者的神经内外科治疗效果，总结相应的手术适应证。方法 统计金谷分类Ⅳb 级和Ⅴ级基底节脑出血患者（各100 例）神经内外科治疗效果，采用高血压重症基底节-丘脑血肿CT 分型法探讨影响疗效的相关因素。结果 手术治疗组总病死率为62%（62/100），低于保守治疗组的92%（92/100；χ2 = 23.744，P = 0.000）；CT 分型Ⅲ ~ Ⅴ型患者总病死率为84.21%（32/38），高于Ⅰ ~ Ⅱ型的48.39%（30/62；Fisher 精确概率法：P = 0.000）；开颅手术组患者总病死率为54.41％（37/68），低于非开颅手术组的78.13％（25/32；χ2 = 7.920，P = 0.048）。结论 金谷分类Ⅳb 级极重型基底节脑出血患者应积极施行手术治疗，而Ⅴ级患者应慎行手术，需结合患者年龄（< 60 岁）、脑疝症状出现时间（发病时间> 12 h）、CT 分型（Ⅰ ~ Ⅱ型）及是否伴有全身性疾病（无心、肺、肝、肾等重要脏器疾病和糖尿病）等多项因素综合考虑，制定治疗方案。

关键词: 颅内出血, 高血压性, 基底神经节, 血肿, 药物疗法, 神经外科手术