多点穿刺持续灌洗治疗重症高血压脑出血的疗效探讨  

Treatment of great hematoma in brain hemorrhage with multi-point puncture and continuous irrigation-draining

作　　者：黄晓明[1] 陈世平[1] 程文[1] 袁晓东[1] 唐文华[1] 

机构地区：[1]成都铁路中心医院神经外科,610081

出　　处：《中华医学杂志》2008年第39期2786-2788,共3页National Medical Journal of China

摘　　要：目的探讨多点穿刺抽吸持续尿激酶灌洗治疗重症高血压脑出血巨大血肿的临床效果。方法将GCS评分3—9分出血量较大的重症高血压脑出血94例患者，随机分成多点穿刺抽吸持续尿激酶灌洗引流（多点组）和单点穿刺抽吸尿激酶间断注入引流（单点组）两组，观察两组患者的预后、血肿消除时间及再出血等指标。结果多点组恢复良好率为78．26％。单点组恢复良好率为64．58％。多点组良好率明显提高（P〈0．05）。多点组病死率为10．87％，单点组死病率为20，83％，多点组病死率低于单点组（P〈0．05）。多点组15d内血肿消除占为67．43％，单点组15d内血肿消除仅占23．68％（P〈0．01）。多点组再出血的发生率为8．69％，单点穿刺组为12．50％，两组比较P〈0．05。结论（1）多点穿刺对较大的和不规则的血肿具有更有效的抽吸和引流，解除脑受压。（2）持续尿激酶灌洗方法可使尿激酶长久的保持血肿腔内的有效浓度，对血块不间断的冲刷，促进其液化和引流，缩短了血肿消除时间。Objective To investigate the clinical effect of multi-point aspiration combined with continuous irrigation with urokinase in treating great hematoma as the result of brain hemorrhage due to hypertension. Methods Ninety-four patients with great hematoma as the result of brain hemorrhage due to hypertension, aged 70, were randomly divided into 2 equal groups ： one point puncture group and multi-point puncture group. Both groups underwent puncture under local or general anesthesia and were irrigated with urokinase continually. The outcomes were recorded and analyzed. Results The case-fatality rate of the multipoint puncture group was 10. 87, significantly lower than that of the one-point puncture group （20. 83, P 〈 0.05 ）. The superiority rate of recovery of the multi-point group was 78.26%, significantly higher than that of the one-point puncture group （64. 58% ,P 〈0. 05）. In 15 days, the resolution rate of brain hematoma of the multi-point group was 67.43%, significantly higher than that of the one point puncture group （23.68%, P 〈0.01 ）. The re-hemorrhage rate of the multi-point puncture group was 8.95% , significantly lower than that of the one-point puncture group （ 12. 5% ,P 〈 0.05 ）. Conclusion Multi-point puncture and continuous irrigation decrease the intracranial pressure quickly and suck the hematoma more effectively, especially for the great and irregular hematoma of brain. Continuous urokinase irrigation-drainage is able to keep the concentration of urokinase at an effective level, thus continuously washing, liquefying, draining, and resolving the brain hematoma.

关 键 词：高血压脑出血 颅内血肿穿刺术 持续灌洗引流 尿激酶 

分 类 号：R686[医药卫生—骨科学]