立体定向引导血肿穿刺引流术联合尿激酶治疗中等量高血压脑出血的疗效  

Clinical efficacy of stereotactic-guided hematoma puncture drainage combined with urokinase therapy on medium hypertensive cerebral hemorrhage

作　　者：王衍廷[1] 黄建睿 李庆民[1] 袁绍纪[1] 

机构地区：[1]中国人民解放军济南军区总医院神经外科全军神经外科专科中心,济南250031

出　　处：《中国实用神经疾病杂志》2016年第5期21-22,共2页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨立体定向引导微创血肿穿刺引流联合尿激酶治疗中等量高血压脑出血的临床效果。方法回顾性分析87例高血压脑出血病例,均为幕上出血,血肿量25~60mL,47例采用立体定向引导微创血肿穿刺引流联合尿激酶治疗,40例采用开颅血肿清除术治疗,分别于术后3d、7d观察血肿残余量、术后再出血情况、术后并发症情况;比较2组术后7d、14d、28d的临床疗效。结果立体定向引导微创血肿穿刺联合尿激酶组术后3d残余血肿量为（8.7±4.5）mL,7d为（2.5±1.3）mL,术后28d有效率为74.6%,术后并发症发生率为30.3%,与手术组比较差异均有统计学意义（P〈0.05或P〈0.01）;术后再出血发生率为4.3%,与手术组比较差异无统计学意义（P〈0.05）。结论立体定向引导微创血肿穿刺联合尿激酶是治疗中等量高血压脑出血安全有效的方法,值得临床推广应用。Objective To explore clinical curative effect and prognosis of stereotactic-guided minimally invasive hematoma puncture drainage combined with urokinase in the amount of hypertensive cerebral hemorrhage. Methods We retrospectively an- alyzed 87 cases with supratentorial hypertensive cerebral hemorrhage of hematoma volume between 25 and 60 mL. Forty-seven patients in the study group received stereotactic-guided minimally invasive hematoma puncture drainage combined with uroki- nase therapy. Meanwhile,40 patients in the control group were treated with craniotomy evacuation of hematoma. The residual hematoma volume,postoperative re-hemorrhage,postoperative complications were observed on the 3rd,Tth day after operation and the clinical efficacy was compared in two groups on the 7th, 14th, 28th day. Results In the study group, residual hematoma volume were （8.7 ± 4.5）mL on the 3rd day and（2.5 ± 1.3） mL on the 7th day after operation, in addition, effective rate was 74.6 % after 28-day operation, and the incidence of postoperative complications was 30.3%, which showed statistical difference compared with the control group （P〈0.05）. The incidence of postoperative re-hemorrhage in the study group was 4. 3%, there was no significant difference compared with control group （P〈0.05）. Conclusion Stereotactic-guided minimally invasive hematoma puncture combined with urokinase is a safe and effective method in the treatment of medium hypertensive cerebral hemorrhage, which should be worthy of wide application in clinic.

关 键 词：血肿穿刺 尿激酶 开颅手术 高血压脑出血 

分 类 号：R743.34[医药卫生—神经病学与精神病学]