颅内压监测下尿激酶脑室内灌洗在高血压性脑室内血肿治疗中的策略探讨

目的探讨高血压脑室内出血微创钻孔穿刺置管尿激酶灌洗外引流的临床疗效。方法回顾性分析本院2011年6月~2013年6月收治的高血压性脑室内出血患者52例,根据不同的尿激酶水平和治疗时间,并设立对照组（采用单纯双额骨微创钻孔穿刺置管外引流手术）,记录评估颅内血肿的变化情况、血肿变化与尿激酶灌洗的时间关系、患者日常生活能力（ADL）分级评估、灌洗手术前后GOS评分状况等。结果本组共纳入52例患者,术后3个月,GOS评分5分14例,4分23例,3分15例;ADL分级Ⅰ级14例,Ⅱ级23例,Ⅲ级14例,Ⅳ级1例。与对照组相比,尿激酶脑室内灌洗组在术后颅内压监测、ADL评分、GOS评分等方面具有一定优势。结论高血压脑出血患者出血情况稳定后,早期应用尿激酶治疗组预后相对较好,适当的尿激酶时间剂量组合有助于脑室内出血患者的恢复,颅内压监测下尿激酶脑室内灌洗对高血压脑出血脑室内血肿的治疗效果明显,操作简便、创伤小、安全有效、预后较好。

The strategy discussion of urokinase intraventricular lavage under intracranial pressure monitoring in the treatment of hypertensive intraventricular hematoma

Objective To investigate the clinical effect of the external drainage of urokinase lavage via minimally invasive drilling puncture catheter indwelling in patients with hypertensive intraventricular hemorrhage. Methods Data of52 patients with hypertensive intraventricular hemorrhage in our hospital from June 2011 to June 2013 treated with different concentrations of urokinase and at different time were retrospectively analysed.The simple external drainage via bilateral frontal minimally invasive drilling puncture catheter indwelling was used in control group.The changes of intracranial hematoma,the relationship between the change of hematoma,the time of urokinase lavage,the patients′ ADL grade,the GOS score before and after the lavage were recorded and evaluated. Results There were 52 patients,after operation of 3 months,the cases of GOS score of 5,4,3 was 14,23,15 cases respectively and 14 cases were ADL grade Ⅰ,23 cases were grade Ⅱ,14 cases were grade Ⅲ,only 1 case was grade Ⅳ.Compare with control group,the group of intraventricular urokinase lavage had certain advantage in ICP,ADL grade and GOS score. Conclusion When patients with hypertensive cerebral hemorrhage are in stable state,the early application of urokinase has a better prognosis.The appropriate urokinase concentration and therapy time can also contribute to the patient′s recovery.Urokinase intraventricular lavage under intracranial pressure monitor has a considerable curative effect for intraventricular hematoma in patients with hypertension cerebral hemorrhage and this kind of operation is easy for handling,little trauma,safe and effective and with a better prognosis.