腦出血微創(chuàng)鉆孔引流與尿激酶對顱內血塊溶解的效果對比

王晶 黃莉

【摘 要】 ?目的 ： 對比腦出血微創(chuàng)鉆孔引流與尿激酶對顱內血塊溶解的效果。方法 ： 2018年4月至2019年4月選擇在本院診治的腦出血患者84例，隨機分為兩組。研究組給予微創(chuàng)鉆孔引流治療，對照組給予尿激酶治療，記錄顱內血塊溶解效果。結果 ： 治療后觀察組的總有效率顯著高于對照組（P<0.05）;治療后觀察組的血腫清除率顯著高于對照組（P<0.05）;治療后兩組的血清GFAP含量都顯著低于治療前，觀察組也顯著低于對照組（P<0.05）;觀察組閉管時間及引流時間都顯著少于對照組（P<0.05）。結論 ： 相對于尿激酶，微創(chuàng)鉆孔引流在腦出血中的應用能促進顱內血塊溶解，抑制血清GFAP的釋放，減少閉管時間及引流時間，從而提高治療效果。

【關鍵詞】 ?微創(chuàng)鉆孔引流;尿激酶;腦出血;顱內血塊

Comparison of the effect of minimally invasive drilling drainage and urokinase on intracranial blood clot lysis in patients with cerebral hemorrhage

Wang Jing， Huang Li

Fourth People's Hospital of Tianshui， Tianshui， Gansu 741020

[Abstract] ?Objective：To compare the effects of minimally invasive drilling drainage and urokinase on intracranial blood clot lysis in patients with cerebral hemorrhage. Methods： From April 2018 to April 2019， 84 patients with cerebral hemorrhage were selected and divided into two groups. The study group was treated with minimally invasive drilling drainage， while the control group was treated with urokinase. The effect of intracranial blood clot dissolution was recorded. Results： After treatment， the total effective rate of the study group was significantly higher than that of the control group （P<0.05）. After treatment， the hematoma clearance rate in the study group was significantly higher than that in the control group （P<0.05）. After treatment， the serum GFAP content in both groups was significantly lower than that before treatment， and the study group was also significantly lower than that in the control group （P<0.05）. The closure time and drainage time of the study group were significantly less than those of the control group （P<0.05）. Conclusion： Compared with urokinase， the application of minimally invasive drilling drainage in cerebral hemorrhage can promote the dissolution of intracranial blood clots， inhibit the release of serum GFAP， reduce the time of closure and drainage， and thus improve the therapeutic effect.

[Key words] Minimally invasive drilling drainage; Urokinase; Cerebral hemorrhage; Intracranial blood clot

腦出血是嚴重危害人類健康的常見病，具有高發(fā)病率、高致殘率、高病死率等“三高”特征。流行病學顯示我國腦出血患者占所有腦血管疾病患者的30.0%左右，1個月內的病死率接近20.0%[1]。特別是腦出血后引起機體和腦組織局部一系列病理性反應，包括腦內血腫的擴大，從而釋放出大量的血管活性物質，誘發(fā)機體出現腦水腫，并可導致局部腦血流量減少[2]。隨著醫(yī)學技術的發(fā)展，微創(chuàng)技術在腦出血患者中的應用越來越多。其中腦出血微創(chuàng)鉆孔引流具有操作簡單、創(chuàng)傷小、并發(fā)癥少、易于掌握、效果確切等優(yōu)點，能減少因血腫占位、血腫毒性引發(fā)的腦組織損害，促進患者恢復[3]。而尿激酶經引流管注入可加速腦內血腫自引流管排出，也可促進血腫溶解液化，減少并發(fā)癥的發(fā)生，有助于提高臨床療效，降低致死率、致殘率。神經膠質纖維酸性蛋白（Glial fibrillary acidic protein，GFAP）是一種中間絲蛋白，被認為是 星形膠質細胞的特異性標志物，是星形膠質細胞的細胞骨架[4]。本文對比了腦出血微創(chuàng)鉆孔引流與尿激酶對顱內血塊溶解的效果，以明確其應用價值與機制。現總結報道如下。

參考文獻

[1] ?嚴鵬程.腦出血臨床流行病學變化趨勢分析[D].重慶：重慶醫(yī)科大學，2011.

[2] 譚衛(wèi)國，孫曉歐.高血壓腦出血破入腦室的外科臨床治療體會[J].養(yǎng)生保健指南，2019，（06）：97.

[3] Gong X，Hu A，Li X，et al.Coordinated expression of vascular endothelial growth factor A and urokinase-type plasminogen activator contributes to classical swine fever virus Shimen infection in macrophages[J].BMC Vet Res，2019，15（01）：82.

[4] Xu N，Meng H，Liu T，et al.Treatment of acute thromboembolic complication after stent-assisted coil embolization of ruptured intracranial aneurysm： a case report[J].Neuropsychiatr Dis Treat，2019，（15）：69-74.

[5] 麗敏，于芳蘋，張黎，等.鹽酸法舒地爾對腦出血大鼠炎性反應及繼發(fā)性腦損傷的影響研究[J].中華神經醫(yī)學雜志，2017，16（11）：1081-1090.

[6] Zhang D，Zhang C，Lan S，et al.Near-Infrared Light Activated Thermosensitive Ion Channel to Remotely Control Transgene System for Thrombolysis Therapy[J].Small，2019，15（27）：e1901176.

[7] 唐曉輝.尿激酶與重組組織型纖溶酶原激活劑超早期靜脈溶栓治療急性腦梗死的療效和安全性比較[J].中國醫(yī)師進修雜志，2012，35（25）：59-61.

[8] 李顯鋒.穿刺引流術中應用尿激酶治療老年高血壓腦出血的療效分析[J].世界復合醫(yī)學，2019，05（02）：121-123.

[9] 辛曉東，宋暢，郝萬如.腦出血血腫穿刺引流術后顱內感染病原體分布及危險因素分析[J].中西醫(yī)結合心腦血管病雜志，2019，17（05）：794-796.

[10]Zhu C，Zhuo H，Qin Y，et al.Comparison of clear effect and the complications， and short and mid-term effects between ultrasound-guided and non-guided catheter-directed thrombolysis in the treatment of deep venous thrombosis of lower extremity[J].Vascular，2019，27（03）：277-283.