阿替普酶辅助颅内血肿微创手术在中等量基底节区脑出血治疗中的临床疗效  

Clinical effect of minimally invasive operation that alteplase assisted for the patients with moderate amount of cerebral basilar hemorrhage

作　　者：刘长霞 曹茂红[2] 

机构地区：[1]盐城市第一人民医院神经内科,224001 [2]南通大学附属医院神经内科

出　　处：《临床神经病学杂志》2017年第6期405-409,共5页Journal of Clinical Neurology

基　　金：国家自然科学基金(81471188)

摘　　要：目的探讨阿替普酶辅助颅内血肿微创手术对基底节区中等量脑出血临床疗效和安全评估。方法选取我院从2012年1月~2016年7月收治的GCS评分8~10分的基底节区中等量脑出血患者63例,分为实验组和对照组,实验组进行阿替普酶辅助颅内血肿微创手术治疗,对照组给予内科保守治疗。通过GCS、NIHSS、日常生活活动能力量表(ADL)及mRS量表评价两组患者治疗效果,并进行比较。结果两组患者出血量在治疗前无明显差异;出院时复查CT显示,实验组治疗后血肿几乎全部清楚或吸收,对照组血肿量无明显减少,两组之间具有统计学意义(P<0.05)。实验组治疗后NIHSS评分较治疗前明显下降(P<0.05),而对照组治疗前后变化无明显统计学差异。实验组治疗后GCS评分较治疗前明显增加(P<0.05)。出院3个月后实验组患者的ADL评分较对照组明显增加(P<0.05),mRS评分较对照组明显降低(P<0.05)。结论阿替普酶辅助颅内血肿微创手术治疗基底节区脑出血能更快清除颅内血肿,减轻血肿压迫造成的脑损伤,从而减少患者致残率和死亡率,安全有效。Objective To investigate the clinical effect and safety of the treatment of cerebral hemorrhage of basal ganglia regionin middle volume with minimally invasive surgery combined with alteplase. Methods Sixty-three patients with moderate amount of cerebral basilar hemorrhage and their GCS scores were between 8 to 10 in our hospital from 2012 to 2016 were divided into experimental group and control group. The experimental group were taken by minimally invasive surgery for intracranial hematoma combined with alteplase,otherwise,the patients in the control group were treated by medical conservative treatment. GCS,NIHSS,activities of daily living（ ADL）,mRS were used to evaluated the efficacy,the results were compared. Results The amount of bleeding in two groups had no significant difference before treatment. However,the experimental group of hematoma was neaely clear up or almost all absorped,the control group was not significantly reduced after treatment according to review of CT,there was statistical significance between the two groups（ P 0. 05）. In the experimental group,NIHSS score was significantly decreased after treatment than before treatment（ P 0. 05）,while there was no statistically significant difference in the control group. In the experimental group,GCS score was significantly decreased after treatment than before treatment（ P 0. 05）. Three months after discharge,the ADL score of the experimental group was significantly higher than that of the control group（ P 0. 05）,the mRS score of the experimental group after 3 months was significantly lower than that of the control group（ P 0. 05）. Conclusion Treatment to basal ganglia cerebral hemorrhage of minimally invasive surgery combined with alteplase is more safe and effective by removing intracranial hematoma quickly,reducing brain damage caused by hematoma compression and thereby deseasing morbidity and mortality.

关 键 词：阿替普酶 颅内血肿微创术 高血压脑出血 

分 类 号：R651.12[医药卫生—外科学]