比较微创手术联合尿激酶和开颅血肿清除术在高血压性基底节出血患者中的临床疗效  

Comparison of clinical efficacy between minimally invasive surgeries combined with urokinase and craniotomy hematoma evacuation in patients with hypertensive basal ganglia hemorrhage

作　　者：胡尚统[1] 周格知[1] 潘利飞[2] 

机构地区：[1]金华市中心医院神经外科,浙江金华321300 [2]金华市中心医院重症医学科

出　　处：《中华全科医学》2017年第6期937-939,943,共4页Chinese Journal of General Practice

基　　金：2010年省市共建医药卫生专项目基金计划(2010-SSA007);2014年浙江省医药卫生一般研究计划项目(2014KYB294)

摘　　要：目的高血压性基底节出血治疗方法尚未有金标准,比较神经导航下微创手术联合尿激酶和开颅血肿清除术在高血压性基底节出血患者中的临床疗效,为治疗高血压性基底节出血提供依据。方法前瞻性收集2014年1月—2016年6月金华市中心医院收治的高血压性基底节出血患者126例。将患者随机分为研究组和对照组,每组各63例。研究组采用微创手术联合尿激酶(10 000 U/次)治疗,对照组采用开颅血肿清除术。主要观察指标包括:手术时间、格拉斯哥昏迷评分(术前,术后第1、14天)、血肿清除率、器官功能衰竭、再出血率、颅内感染、肺部感染、住院时间和28 d死亡率。结果 2组患者术前格拉斯哥昏迷评分差异无统计学意义(8.52±1.78 vs.8.40±1.74,t=0.335,P=0.739)。但与对照组比较,术后第1天和术后第14天时研究组患者格拉斯哥昏迷评分显著增高[(11.06±1.94 vs.10.04±2.08,t=2.584,P=0.011)和(13.60±1.19 vs.11.90±1.87,t=5.500,P<0.001)]。2组患者血肿清除率差异无统计学意义[(93.65±7.56)%vs.(94.11±5.32)%,t=0.375,P=0.832]。但与对照组比较,研究组手术时间显著缩短(135.90±17.41)min vs.(149.39±19.14)min,t=3.757,P<0.001)。与对照组比较,研究组患者住院时间显著缩短(21.45±5.67)d vs.(25.67±7.45)d,t=3.148,P<0.001)。2组患者28 d死亡率、器官功能衰竭、再出血、颅内感染和肺部感染等差异无统计学意义(P>0.05)。结论微创手术联合尿激酶治疗基底节出血有助于促进患者神经功能恢复,加快术后康复。Objective There was no golden standard for the treatment of hypertensive basal ganglia hemorrhage. The present study was to compare the clinical efficacy of minimally invasive surgical procedures combined with urokinase and craniotomy hematoma evacuation in patients with hypertensive basal ganglia hemorrhage and to provide basis for treatment of hypertensive basal ganglia hemorrhage. Methods From January,2014 to June,2016,126 cases of hypertensive basal ganglia hemorrhage in our hospital were prospectively collected. The patients were randomly divided into study group and control group with 63 cases in each group. The study group received minimally invasive surgery combined with urokinase（ 10 000 U/times）,while the control group underwent craniotomy hematoma evacuation. The main outcome measures included the operation time,Glasgow coma score（ 0,1 and 14 days）,hematoma clearance rate,organ failure,re-bleeding rate,intracranial infection,pulmonary infection,hospitalization time and 28-days mortality. Results There was no significant difference between the two groups in Glasgow coma score（ 8. 52 ± 1. 78 vs. 8. 40 ± 1. 74,t = 0. 335,P = 0. 739） before the operation. But compared with the control group,at the first day and at the 14-days after the operation,patients in the study group got significant higher levels of Glasgow coma score [（ 11. 06 ± 1. 94 vs. 10. 04 ± 2. 08,t = 2. 584,P =0. 011） and（ 13. 60 ± 1. 19 vs. 11. 90 ± 1. 87,t = 5. 500,P〈0. 001） ]. There was no significant difference in the rate of hematoma clearance between the two groups（ 93. 65 ± 7. 56 vs. 94. 11 ± 5. 32 %,t = 0. 375,P = 0. 832）. But compared with the control group,the operation time of the study group was significantly shorter（ 135. 90 ± 17. 41 vs. 149. 39 ± 19. 14 min,t = 3. 757,P〈0. 001）. When compared with the control group,the hospitalization time of the study group was significantly shorter（ 21. 45 ± 5. 67 vs. 25. 67 ± 7. 45 d,t = 3. 148,P〈0. 001）. There were no significant differences

关 键 词：基底节出血 微创手术 尿激酶 开颅血肿清除术 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]