颅内血肿穿刺尿激酶液化与去骨瓣减压血肿清除治疗高血压脑出血患者的疗效对比

doi:10.3760/cma.j.issn.1007-1245.2023.14.017

国际医药卫生导报 ›› 2023, Vol. 29 ›› Issue (14): 2001-2004.DOI: 10.3760/cma.j.issn.1007-1245.2023.14.017

颅内血肿穿刺尿激酶液化与去骨瓣减压血肿清除治疗高血压脑出血患者的疗效对比

石怀智李骥腾张春声

巴彦淖尔市医院神经外科，巴彦淖尔　015000

收稿日期:2022-11-21 出版日期:2023-07-15 发布日期:2023-07-31
通讯作者: 张春声，Email：13088472000@163.com
基金资助:
巴彦淖尔市科技计划项目合同书（Y201609）

Intracranial hematoma puncture urokinase liquefaction versus decompressive hematoma removal through bone flap in treatment of patients with hypertensive intracerebral hemorrhage

Shi Huaizhi, Li Jiteng, Zhang Chunsheng

Department of Neurosurgery, Bayannur Hospital, Bayannur 015000, China

Received:2022-11-21 Online:2023-07-15 Published:2023-07-31
Contact: Zhang Chunsheng, Email: 13088472000@163.com
Supported by:
Project of Plan of Science and Technology in Bayannur (Y201609)

摘要/Abstract

摘要：

目的　对比分析颅内血肿穿刺尿激酶液化与去骨瓣减压血肿清除治疗高血压脑出血患者的疗效。方法　选取2018年8月至2022年8月在巴彦淖尔市医院收治的84例高血压脑出血患者作为研究对象，按治疗方法分为观察组与对照组。观察组41例，其中男性23例，女性18例，年龄41～73（63.2±9.5）岁，接受颅内血肿穿刺尿激酶液化术治疗；对照组43例，其中男性21例，女性22例，年龄43～76（59.3±11.8）岁，接受去骨瓣减压血肿清除术治疗。比较两组患者手术情况、住院花费、格拉斯哥预后（GOS）评分。统计学方法采用χ²检验、t检验。结果　观察组手术时间、治疗费用、住院天数明显低于对照组［（0.82±0.24）h比（3.61±0.56）h、（46 380.51±35 633.35）元比（72 834.60±32 785.26）元、（15.52±13.50）d比（23.32±16.83）d］，差异均有统计学意义（t=29.42、3.48、2.34，均P<0.05）。治疗后，观察组的美国国立卫生研究院卒中量表（NIHSS）评分低于对照组［（12.87±3.13）分比（18.98±4.85）分］，观察组Barthel 指数评分高于对照组［（82.23±7.94）分比（56.88±6.79）分］，差异均有统计学意义（t=6.82、15.75，均P<0.05）。结论　颅内血肿穿刺尿激酶液化术治疗高血压脑出血与去骨瓣减压血肿清除术相比，颅内血肿穿刺尿激酶液化术更为安全、有效，能明显缩短手术时间、减轻神经组织损伤，有利于术后康复，缩短术后住院时间，减少住院费用，从而改善患者生活质量。

关键词:

高血压脑出血, 颅内血肿穿刺, 尿激酶, 去骨瓣减压术

Abstract:

Objective　To analyze the effects of intracranial hematoma puncture urokinase liquefaction versus decompressive hematoma removal through bone flap in the treatment of patients with hypertensive intracerebral hemorrhage. Methods　Eighty-four patients with hypertensive intracerebral hemorrhage admitted to Bayannur Hospital from August 2018 to August 2022 were selected as the research objects. There were 41 cases in the observation group, including 23 males and 18 females; they were 41-73 (63.2±9.5) years old. There were 43 cases in the control group, including 21 males and 22 females; they were 43-76 (59.3±11.8) years old. The observation group were treated with intracranial hematoma puncture urokinase liquefaction, and the control group with decompressive hematoma removal through bone flap. The surgical status, hospitalization costs, and scores of Glasgow Outcome Scale (GOS) in the 2 groups were compared. χ² and t tests were applied. Results　The operation time, treatment cost, hospital stay in the observation group were lower than those in the control group [(0.82±0.24) h vs. (3.61±0.56) h, (46 380.51±35 633.35) yuan vs. (72 834.60±32 785.26) yuan, (15.52±13.50) d vs. (23.32±16.83) d], with statistical differences (t=29.42, 3.48, and 2.34; all P<0.05). After the treatment, the scores of National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) in the observation group were better than those in the control group [(12.87±3.13) vs. (18.98±4.85) and (82.23±7.94) vs. (56.88±6.79)], with statistical differences (t=6.82 and 15.75; both P<0.05). Conclusion　Intracranial hematoma puncture urokinase liquefaction has the advantages of shorter operation time, lower treatment cost, and shorter hospitalization time than decompressive hematoma removal through bone flap, and is safe and effective and can reduce neurological damage and improve the patients rehabilitation and life quality.

Key words:

Hypertensive cerebral hemorrhage, Puncture of intracranial hematoma, Urokinase liquefaction, Decompression through bone flap

石怀智李骥腾张春声.

颅内血肿穿刺尿激酶液化与去骨瓣减压血肿清除治疗高血压脑出血患者的疗效对比 [J]. 国际医药卫生导报, 2023, 29(14): 2001-2004.

Shi Huaizhi, Li Jiteng, Zhang Chunsheng.

Intracranial hematoma puncture urokinase liquefaction versus decompressive hematoma removal through bone flap in treatment of patients with hypertensive intracerebral hemorrhage [J]. International Medicine and Health Guidance News, 2023, 29(14): 2001-2004.

参考文献

[1] 中华医学会神经外科学分会,中国医师协会急诊医师分会,国家卫生和计划生育委员会脑卒中筛查与防治工程委员会.自发性脑出血诊断治疗中国多学科专家共识[J].中华急诊医学杂志,2015,24(12):1319-1323. DOI:10.3760/cma.j.issn.1671-0282.2015.12.003.
[2] 张福征,王才永,张磊,等.神经内镜与开颅手术治疗高血压脑出血的疗效比较[J].中华神经外科杂志,2015,31(1):19-21.DOI:10.3760/cma.j.issn.1001-2346.2015.01.005.
[3] 李恩,崔丙周.两种手术方式治疗高血压脑出血的分析比较[J].中国实用神经疾病杂志,2011,14(8):68-69.DOI:10.3969/j.issn.1673-5110.2011.08.042.
[4] 王彦,王学娟,郑娜,等.分析CT引导下微创引流术对于高血压性脑出血治疗的临床疗效[J].影像研究与医学应用,2017,1(1):83-84.
[5] 裴明和,梁合,孙捷,等.不同外科治疗方案治疗老年高血压脑出血患者的疗效比较[J].中国老年学杂志,2018,38(22):5478-5480.
[6] 周勤伟,刘民,奚少东,等.内镜及显微手术治疗基底节区高血压脑出血的临床疗效比较[J].中华神经医学杂志,2018,17(3):301-305.DOI:10.3760/cma.j.issn.1671-8925. 2018.03.015.
[7] 阿布都克尤木·阿布都吉力力,帕热哈提江·依孜木,李津生,等.两种不同手术方式治疗基底节区高血压脑出血的临床疗效[J].临床神经外科杂志,2018,15(5):354-357,361.DOI:10.3969/j.issn.1672-7770.2018.05.009.
[8] 唐华民,周建国,张剑锋,等.两种手术方式治疗高血压脑出血的对比研究[J].中华急诊医学杂志,2018,27(4):425-429.DOI:10.3760/cma.j.issn.1671-0282.2018.04.018.
[9] Dowlatshahi D,Wasserman JK,Momoli F,et al.Evolution of computed tomography angiography spot sign is consistent with a site of active hemorrhage in acute intracerebral hemorrhage[J].Stroke,2014,45(1):277-280.DOI:10.1161/STROKEAHA.113.003387.
[10] 张波,温权,甘元华,等.开颅血肿清除去骨瓣减压术与微创钻孔引流联合尿激酶溶解术对高血压脑出血患者颅内压影响的对比研究[J].实用心脑肺血管病杂志,2016,24(9):59-62.DOI:10.3969/j.issn.1008-5971.2016.09.015.
[11] 张伟,姜晓东,蔡体平,等.高血压脑出血的外科治疗进展[J].医学综述,2013,19(22):4135-4138.DOI:10.3969/j.issn.1006-2084.2013.22.035.
[12] Min X,Cun-Zu W,Yun-Huan W,et al.Effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury[J].Turk Neurosurg,2014,24(2):241-245.DOI:10.5137/1019-5149.JTN.8154-13.1.
[13] Zhou H,Zhang Y,Liu L,et al.A prospective controlled study: minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage[J].BMC Neurol,2011,11:76.DOI:10.1186/1471-2377-11-76.
[14] 江澈,陈状.脑出血微创手术治疗的现代观点[J].中国微侵袭神经外科杂志,2016,21(4):182-185.DOI:10.11850/j.issn.1009-122X.2016.04.017.
[15] 谢军,曹友林,王振国,等.神经内镜颅内血肿清除术和软通道血肿穿刺引流术治疗高血压性脑出血的临床对比研究[J].中西医结合心脑血管病杂志,2021,19(9):1562-1565.DOI:10.12102/j.issn.1672-1349.2021.09.030.
[16] 匡德利,许西海,符艳松.神经内镜辅助去骨瓣血肿清除术治疗高血压脑出血的效果及对患者神经功能、预后的影响[J].临床误诊误治,2021,34(5):106-111.DOI:10.3969/j.issn.1002-3429.2021.05.021.
[17] 杨平来,张源源,周立田.高血压脑出血急性期微创颅内血肿清除术与去骨瓣减压血肿清除术的临床疗效对比[J].神经损伤与功能重建,2015(6):561-563.DOI:10.3870/sjsscj.2015.06.035.
[18] 郭良文.两种手术方式及保守治疗高血压性基底节区脑出血临床比较[J].中国实用神经疾病杂志,2016,19(4):66-68.DOI:10.3969/j.issn.1673-5110.2016.04.038.
[19] 罗云辉.立体定向锥颅颅内血肿穿刺软通道引流术与骨瓣减压颅内血肿清除术治疗脑出血的效果比较[J].中国当代医药,2021,28(22):83-85.DOI:10.3969/j.issn.1674-4721. 2021.22.024.
[20] 蒋霞,周丽凤,段丽娜,等.快速康复外科护理在微创颅内血肿穿刺引流术治疗的高血压脑出血患者中的应用效果[J].中国医药导报,2022,19(16):183-186.
[21] 费喜峰,王之敏,孙飞,等.YL-1型针联合尿激酶注射在治疗中等量基底节区脑出血中的应用[J].实用医学杂志,2022,38(11):1314-1318. DOI:10.3969/j.issn.1006-5725. 2022.11.003.

颅内血肿穿刺尿激酶液化与去骨瓣减压血肿清除治疗高血压脑出血患者的疗效对比

Intracranial hematoma puncture urokinase liquefaction versus decompressive hematoma removal through bone flap in treatment of patients with hypertensive intracerebral hemorrhage

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

编辑推荐

Metrics