尿激酶冲洗在脑出血微创穿刺引流术中的应用价值

Application Value of Urokinase Irrigation in Minimally Invasive Puncture and Drainage of Intracerebral Hemorrhage

关键词:  脑出血  微创穿刺引流术  尿激酶  神经功能缺失  疗效

Key words:  intracerebral hemorrhage  minimally invasive puncture and drainage  urokinase  neurological functional deficit  curative effect

摘要:

目的 探讨尿激酶冲洗在脑出血微创穿刺引流术中的应用价值。方法 选择幕上自发性脑出血患者106例，随机分为对照组51例，观察组55例。2组病例均予以内科治疗方法加微创穿刺引流术治疗，对照组每次予以尿激酶2×10⁴~5×10⁴ U一次性灌注液化引流，观察组予以尿激酶2×10⁴~5×10⁴ U加入0.9%氯化钠30 mL溶解后反复冲洗。比较2组术前、术后第3，5，14天的血肿、血肿周围低密度区体积和美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分；比较2组的拔除血肿引流管时间；比较2组病例再出血、颅内感染、卒中相关性肺炎（stroke-associated pneumonia，SAP）、中枢性高热、应激性黏膜病变（stress related mucosal disease，SRMD）的发生率；比较2组病例术后3个月的累计病死率、改良Rankin量表（modified Rankin Scale，mRS）评分、Barthel指数评分。结果 与对照组比较，观察组术后第3，5，14天血肿体积明显减小（P<0.05或P<0.01）；与对照组比较，观察组术后第5，14天血肿周围低密度区体积减小、NIHSS评分降低（P<0.05或P<0.01）；观察组的拔除血肿引流管时间低于对照组（P<0.01）；2组病例的再出血、颅内感染、SAP、中枢性高热、SRMD的发生率无显著性差异；术后3个月，2组的累积病死率无显著性差异，观察组的mRS评分低于对照组（P<0.05），Barthel指数评分高于对照组（P<0.05）。结论 尿激酶溶液冲洗用于脑出血微创穿刺引流术的血肿液化，能够缩短血肿清除的时间，减轻脑水肿，改善预后，且不增加再出血和颅内感染的发生率。

Abstract:

OBJECTIVE To explore the application value of urokinase irrigation in minimally invasive puncture and drainage of intracerebral hemorrhage. METHODS One hundred and six patients with supratentorial spontaneous intracerebral hemorrhage were randomly divided into two groups: the control group(51 cases) and the observation group(55 cases). Both groups were treated with internal medicine and minimally invasive puncture and drainage. The control group was treated with urokinase (2×10⁴‒5×10⁴ U) one time perfusion liquid drainage, the observation group was treated with urokinase(2×10⁴‒5×10⁴ U at a time) dissolved in 30 mL of 0.9% sodium chloride of repeated irrigation. Preoperative, and on the 3rd, 5th and 14th day after operation, the volume of hematoma, volume of perihematomal low-density area, and the National Institutes of Health Stroke Scale(NIHSS) score were compared between the two groups; the time of removing hematoma drainage tube was compared between the two groups; the incidence of rebleeding, intracranial infection, stroke-associated pneumonia(SAP), central hyperthermia, stress related mucosal disease(SRMD) were compared between the two groups. The cumulative mortality, modified Rankin Scale(mRS) score, Barthel index score of the two groups at 3 months after operation was compared. RESULTS Compared with the control group, the volume of hematoma in the observation group decreased significantly on the 3rd, 5th and 14th day after operation(P<0.05 or P<0.01). Compared with the control group, the volume of the low density area around the hematoma and the NIHSS score of the observation group was decreased on the 5th and 14th day after operation(P<0.05 or P<0.01). The time of removal of hematoma drainage tube in the observation group was lower than that in the control group(P<0.01). There was no significant difference in the incidence of rebleeding, intracranial infection, SAP, central hyperthermia, SRMD between the two groups. At 3 months after operation, there was no significant difference in the cumulative fatality rate between the two groups, compared with the control group, the mRS score in the observation group were lower, and the Barthel index score in the observation group were higher(P<0.05). CONCLUSION The application of urokinase irrigation for hematoma in minimally invasive puncture and drainage of intracerebral hemorrhage can shorten the clearance time of hematoma, reduce brain edema, improve the prognosis, and do not increase the incidence of rebleeding and intracranial infection.