微创清除术联合活血化瘀法治疗高血压性脑出血的临床研究

目的 研究微创清除术联合丹参注射液治疗高血压性脑出血的疗效.方法 将115例高血压性脑出血患者随机分为治疗组(60例)和对照组(55例).两组均行颅内血肿微创清除术及脱水、止血、抗炎、控制血压等治疗.治疗组同时加用丹参注射液.于术前及术后7、14和21天行CT检查,以测量病灶周围水肿体积;并于术前及术后14天和30天以美国国立卫生研究院卒中量表(NIHSS)评定神经功能缺损程度评分(NDS),同时观察病死率及再出血情况.结果 治疗组和对照组术前、术后7、14和21天血肿周围水肿体积分别为(27.08±2.35)cm3vs(26.33±2.04)cm3、(22.26±1.41)cm3vs(24.05±1.92)cm3、(17.49±1.90)cm3vs(21.40±1.98)cm3、(12.07±1.18)cm3vs(19.31±1.89)cm3,两组术后7、14和21天血肿周围水肿体积逐渐缩小,且均明显小于术前,治疗组术后14天和21天血肿周围水肿体积缩小程度明显大于对照组,差异均有统计学意义(P＜0.05).治疗组和对照组术前、术后14和30天NDS分别为(33.60±5.44)分vs(34.29±4.71)分、(17.37±2.25)分vs(21.95±2.47)分、(7.97±0.71)分vs(15.16±1.12)分,两组术后NDS逐渐降低,治疗组术后14天和30天,NDS评分降低程度明显大于对照组(P＜0.01).两组病死率比较差异无统计学意义,治疗组无持续性出血.结论 丹参注射液能有效减轻微创清除术后高血压脑出血的水肿,促进神经功能的恢复,降低病死率和病残率,提高患者生存质量.

Clinical study of minimally invasive surgery combined with method of activating blood circulation to dissipating blood stasis in treatment of hypertensive intracerebral hemorrhage

Objective To observe the effect of minimally invasive surgery combined with the method of activating blood circulation for dissipating blood stasis in patients with hypertensive intracerebral hemorrhage.Methods A total of 115 patients with hypertensive intracerebral hemorrhage were divided into two groups：treatment group（n=60） and control group（n=55）.All the patients received minimally invasive surgery,dehydration therapy,hemostatics,anti-inflammatory and anti-hypertensive agent.In addition,patients of treatment group were continuously injected intravenously to Salvia miltiorrhiza injection（SMI） for three weeks.Cranial CT was performed to measure the volume of edema around the lesion before and at 7,14 and 21 days after operation,neurologic impairment degree scores（NDS） were assessed by National Institute of Health Stroke Scale（NIHSS）,while the fatality rate and re-hemorrhagic situation were observed before and at 14 and 30 days after initiating the operation.Results The areas of perilesional edema of treatment and control group were（27.08±2.35） cm3 vs（26.33±2.04）cm3,（22.26±1.41） cm3 vs（24.05±1.92） cm3,（17.49±1.90） cm3 vs （21.40±1.98） cm3,（12.07±1.18） cm3 vs（19.31±1.89） cm3 at 0,7,14 and 21 days,respectively.The areas were conspicuously diminished at 7,14 and 21 days after initiating the operation.The areas of perilesional edema of treatment group diminished gradually and significantly smaller than control group at 14 and 21 days（P〈0.05）.In addion,NDS of treatment and control group were（33.60±5.44） scores vs（34.29±4.71） scores,（17.37±2.25） scores vs（21.95±2.47） scores,（7.97±0.71） scores vs（15.16±1.12） scores at 0,14 and 30 days,respectively.NDS in both groups were decreased gradually,more remarkably in the treatment group at 14 and 30 days after operation,neurological function significantly improved（P〈0.01）.No difference in fatality rate was found between two groups,and no continuous bleeding was found in treatment group.Conclusion In patients with hypertensive intracerebral hemorrhage after minimally invasive surgery,SMI can effectively reduce edema around the hematoma,promote the recovery of neurologic function,decrease the fatality rate and the disabled rate,and improve the life quality.