微创软通道和尿激酶治疗高血压脑出血的临床疗效

目的]探讨微创软通道和尿激酶溶解脑内血肿技术治疗高血压脑出血的疗效.方法]将62例高血压脑出血患者随机分为对照组（31例）、实验组（31例）,两组均行微创软通道血肿清除术,对照组每次予2万U尿激酶溶解脑内血肿,试验组每次予10万U尿激酶溶解脑内血肿,观察其治疗效果.结果]试验组血肿基本吸收时间为（2.31±0.80）d,对照组（3.85±1.03）d,试验组明显小于对照组,且两组相比较差异有显著性（F=43.775,P=0.000）;术后5 d意识状态试验组好于对照组（χ2=9.595,P=0.009）;随访6个月,按GOS预后评分,恢复较好（4～5分）试验组26例,占83.87%（26/31）,对照组24例,占77.41%（24/31）,试验组与对照组相比较无显著性差异（P=0.520）.结论]微创软通道血肿清除和尿激酶溶解脑内血肿技术治疗高血压脑出血效果较好,值得推广;大剂量（10万U）尿激酶溶解脑内血肿可明显减少血肿引流时间,促进意识恢复,缩短病程;但随访6个月发现按GOS预后评分来评估,其疗效与尿激酶剂量大小无关.

Clinical Efficacy of Minimally Invasive Soft Channel and Urokinase for the Treatment of Hypertensive Intracerebral Hematoma

Objective] To explore the efficacy ot： minimally invasive soft channel and urokinase for the treatment of hypertensive intracerebral hematoma. Methods] Sixty two patients with hypertensive intracere- bral hematoma were randomly divided into control group （n = 31） and experiment group （n = 31）. Both groups were treated with evacuation of hematoma through minimally invasive soft channel. The control group was given 20000U urokinase to dissolve intracerebral hematoma every time, while the experiment group was given 100000U urokinase to dissolve intracerebral hematoma every time. The efficacy was observed. Results] Basic absorption time of hematoma in the experiment group was （2.31 ± 0.80）d, which was obviously lower than that in the control group （3.85± 1.03）d], and there was significant difference between two groups（F= 43. 775, P =0. 000）. Postoperative 5-day state of consciousness in the experiment group was better than the control group（x2 = 9. 595, P =0. 009）. According to GOS prognostic score, 26 cases in the experiment group （83.87%） and 24 cases in the control group（77.41） after 6 months of follow-up were better recovery（4-5 scores）, but there was no significant difference between two groups（ P =0. 520）. Conclusion] Minimally in- vasive soft channel and urokinase for the treatment of hypertensive intracerebral hematoma has good effect, and is worthy of promotion. Large dose of urokinase（100000U） to dissolve intracerebral bematoma can significantly reduce the time of drainage of hematoma, promote the consciousness recovery and shorten the course of disease. According to GOS prognostic score, there is no significant difference of the prognosis between 100000U urokinase and 20000U urokinase to dissolve intracerebral hematoma.