钻孔置管引流联合尿激酶治疗基底节区脑出血的临床疗效及对炎性因子的影响  

Clinical effect of drilling drainage combined with urokinase in the treatment of basal ganglia hemorrhage and its influence on inflammatory factors

作　　者：邱治春 余能伟[3] 陈礼刚[4] QIU Zhi-chun;YU Neng-wei;CHEN Li-gang(Southwest Medical University,Luzhou 646000,China;Department of Neurosurgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China;Department of Neurology,Sichuan Provincial People s Hospital,Chengdu 610072,China;Department of Neurosurgery,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学,四川泸州646000 [2]成都医学院第一附属医院神经外科,四川成都610500 [3]四川省人民医院神经内科,四川成都610072 [4]西南医科大学附属医院神经外科,四川泸州646000

出　　处：《东南大学学报（医学版）》2018年第2期267-271,共5页Journal of Southeast University(Medical Science Edition)

摘　　要：目的:探究钻孔置管引流术联合尿激酶对基底节区脑出血患者神经功能及炎性因子水平的影响。方法:根据治疗方式的不同将基底节区脑出血患者分为对照组104例和观察组127例。对照组患者给予单纯置管钻孔引流手术治疗;观察组患者给予钻孔置管引流术联合尿激酶治疗,2~4万U·次-1,夹管2 h后开放引流,每天重复2~4次,持续3~5 d。治疗3、5 d复查颅脑CT评估患者颅内血肿清除情况;统计患者拔管时间;治疗3、7、14 d后用NIHSS评分评价两组患者的恢复情况;治疗14 d后检测患者血清中CRP、IL-6及IL-8水平;比较两组患者发生不良反应情况;治疗90 d进行回访,比较两组患者的长期预后。结果:治疗3d和5 d后,CT显示观察组患者颅内血肿清除率明显高于对照组,拔管时间明显缩短,两组比较差异具有统计学意义(P<0.05);治疗7、14 d后两组患者临床症状明显改善,观察组患者在NIHSS评分方面明显优于对照组,差异具有统计学意义(P<0.05);观察组的总有效率和痊愈率明显高于对照组(分别为98.4%vs91.3%;38.6%vs19.2%),差异具有统计学意义(P<0.05);观察组患者的各项炎性因子指标恢复也比对照组明显,两组比较差异具有统计学意义(P<0.05);两组患者均有不良反应发生,差异无统计学意义(P>0.05);两组患者治疗后90 d的NIHSS评分显示观察组患者评分明显优于对照组,差异具有统计学意义(P<0.05)。结论:钻孔置管引流术联合尿激酶可快速改善基底节区脑出血患者神经功能,有效降低患者体内炎性因子的表达。Objective:To investigate the effect of neurological deficit and inflammatory factors treated with drilling drainage combined with urokinase in patients with basal ganglia hemorrhage.Methods:Two-hundred and thirty-one patients with basal ganglia hemorrhage were enrolled in our study.One-hundred and four patients in control group were treated with surgery of drilling drainage,and one-hundred and twenty-seven patients in observation group were treated with surgery of drilling drainage and urokinase(2-4×10 4U at a time,2-4 times·d-1)for 3 to 5 days.Intracranial hematoma was evaluated at 3 d and 5 d after operation;The time of removal of the channel catheter was recorded;National Institutes of Health Stroke Scale(NIHSS)score were used to evaluate the recovery of patients at day 3,7 and 14 after operation.The levels of C-reaction protein,interleukin(IL)-6 and IL-8 as the inflammatory factors at day 14 after operation were detected,and the adverse reactions were recorded in two groups;Follow-up was performed at day 90 after treatment.Results:The intracranial hematoma clearance rate in the observation group was significantly higher than that in the control group at day 3 and 5,the time of removal of the channel catheter was significantly shortened in the observation group than that in the control group(P<0.05).The NIHSS scores of patients in the observation group were better than those in the control group at day 7 and day 14 after treatment(P<0.05);the total efficiency and the recovery rates in the observation group were higher than those in the control group(98.4%vs 91.3%,38.6%vs 19.2%,respectively,P<0.05);inflammatory factors in the observation group were significantly better than those in the control group(P<0.05);adverse reactions between two groups had no significant differences(P>0.05);NIHSS scores were better at day 90 after treatment in the observation group,the difference had statistical significance(P<0.05).Conclusion:The drilling drainage combined with urokinase can effectively improve the neural function

关 键 词：钻孔置管引流 尿激酶 脑出血 基底节 

分 类 号：R651.12[医药卫生—外科学]