脑出血后血肿局部凝血酶与脑水肿、神经功能缺损相关性的临床研究  

Thrombin Related to Cerebral Edema and Neurologic Impairment of Hypertensive Intracerebral Hemorrhage

作　　者：刘育进[1] 尹泽黎[1] 龚细礼[1] 陈德平[1] 刘雄钦[1] 

机构地区：[1]湖南师范大学附属湘东医院,湖南醴陵412200

出　　处：《湖南师范大学学报（医学版）》2011年第4期34-37,40,共5页Journal of Hunan Normal University(Medical Sciences)

基　　金：湖南省卫生厅科研基金资助项目(B2008-069)

摘　　要：目的:探讨高血压脑出血后血肿局部凝血酶与脑水肿、神经功能缺损的相关性。方法:本实验按临床病例对照研究的方法,在决定微创治疗组的同时选择同期住院的与之匹配的病例作常规治疗组对照。常规治疗组30例,微创治疗组32例。微创治疗组在常规治疗的基础上,行颅内血肿微创治疗。常规治疗组分别在起病1d、3d、5d和7d测定外周血清凝血酶浓度、神经功能缺损程度评分以及影像学的脑水肿比值。微创治疗组分别在起病1 d、3 d、5 d和7 d测定外周血清凝血酶浓度和血肿液中凝血酶浓度、神经功能缺损程度评分以及影像学的脑水肿比值。结果:常规治疗组和脑水肿比值第3、5天比值达高峰(P<0.05),微创治疗组脑水肿比值第3天达高峰(P<0.05)。两组脑水肿比值第1、3天比较无差异(P>0.05),第5、7天比较有差异(P<0.05),常规治疗组高于微创治疗组。血肿局部凝血酶浓度和脑水肿比值呈正相关(r=0.663,P<0.05);常规治疗组临床神经功能缺失程度评分第3、5天高于1、7天(P<0.05),微创治疗组临床神经功能缺失程度评分第3天达高峰(P<0.05)。两组第1、3天临床神经功能缺失程度评分比较无差异(P>0.05),第5、7天比较有差异(P<0.05),常规治疗组高于微创治疗组。血肿局部凝血酶和神经功能缺损评分呈正相关(r=0.553,P<0.05)。结论:血肿内凝血酶可能导致脑水肿形成以及影响神经功能缺损评分。Objective To study the relation of thrombin cerebral edema and neurologic impairment of Hypertensive Intracerebral Hemorrhage.Methods The experiment involved two groups.30 patients with cerebral hemorrhage involved in conventional therapy group,taken peripheral blood and measured the concentrations of thrombin at the 1st,the 3rd,the 5th and the 7th days respectively.32 patients with cerebral hemorrhage were enrolled in the minimal invasive treatment group,measured the concentrations of thrombin in blood clot by the needle side of the cranial drill Aspiration,taken peripheral blood and measured the concentrations of serum thrombin at the 1st,the 3rd,the 5th and the 7th days respectively.Brain CT was performed in patients in conventional therapy group and minimal invasive treatment group in order to detect the ratio of brain edema and neurologic impairment score.Results The concentration of serum thrombin reached the peak level at the 3rd day both in conventional therapy group and minimal invasive treatment group(P<0.05).Howerer the concentration of serum thrombin in minimal invasive treatment group reached the peak level rapidly at the 3rd day(P<0.05).There was no significant difference observed in the concentrations of serum thrombin between the two groups(P>0.05).The concentration of hematoma thrombin and the ratio of brain edema were positively correlated in minimal invasive treatment group(r=0.663,P<0.05).The neurologic impairment scores in the 3rd and the 5th days were higher than those in conventional therapy group in the 1st and the 7th days.The neurologic impairment score in minimal invasive treatment group reached the peak level at the 3rd day(P<0.05).There was no significance observed in neurologic impairment scores in the 1st and the 3rd days between the two groups.However the neurologic impairment scores in conventional therapy group were significantly higher than those in minimal invasive treatment group at the 5th and the 7th days(P<0.05).The concentration of thrombin in hematoma and neurologic impai

关 键 词：高血压脑出血 凝血酶 脑水肿 神经功能缺损评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]