氨甲环酸联合开颅血肿清除术治疗中等量基底核区高血压脑出血临床研究

Tranexamic Acid Intravenous Drip Combined with Craniotomy Hematoma Clearance on Coagulation Function in Patients with Moderate Basal Nucleus Hypertensive Intracerebral Hemorrhage

目的探讨氨甲环酸联合开颅血肿清除术对中等量基底核区高血压脑出血的临床疗效,以及对患者凝血功能的影响。方法选取医院2017年1月至2018年2月收治的拟行手术的中等量基底核区高血压脑出血患者80例,随机分为对照组与观察组,各40例。两组患者均行开颅血肿清除术,观察组患者在术中及术后3 d给予氨甲环酸静脉滴注。结果观察组患者术中及术后24 h内出血量均显著少于对照组,再出血发生率显著低于对照组;与治疗前比较,两组患者治疗后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均显著缩短,纤维蛋白原(FIB)含量显著增加,改良的Rankin量表(mRS)评分显著降低,Barthel指数评分显著升高,观察组患者上述指标改善程度均显著优于对照组(P<0.05);观察组与对照组不良反应发生率相当(12.50%比7.50%,χ^2=0.556,P=0.456)。结论氨甲环酸联合开颅血肿清除术治疗中等量基底核区高血压脑出血,能降低患者术中、术后出血量,改善其凝血功能和精神状态、生活质量,降低术后再出血发生率。

Objective To investigate the effect of tranexamic acid intravenous drip combined with craniotomy on coagulation function in patients with moderate basal nucleus hypertensive intracerebral hemorrhage.Methods A total of 80 patients with moderate basal ganglia hypertensive intracerebral hemorrhage who underwent surgical treatment in the hospital from January 2017 to February 2018 were randomly divided into the control group and treatment group,40 cases in each group.Both groups were treated with craniotomy hematoma clearance,while the observation group was treated with continuous intravenous drip of tranexamic acid during and 3 d after operation.Results The amount of bleeding during operation,the amount of bleeding within 24 h and the rate of rebleeding within 3 months after operation in the observation group were lower than those in the control group(P<0.05).Compared with before treatment,the indexes of coagulation function including prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)in the observation group were lower than those in the control group,and fibrinogen(FIB)was higher than that in the control group(P<0.05).At 3 months after operation,the modified Rankine scale(mRS)score of the observation group was lower than that of the control group,and the Barthel index score was higher than that of the control group(P<0.05).The incidence of adverse reactions in the observation group and the control group were 12.50%vs.7.50%,χ^2=0.556,P=0.456).Conclusion Tranexamic acid intravenous drip combined with craniotomy is effective in the treatment of moderate basal ganglia hypertensive intracerebral hemorrhage.It can reduce the amount of bleeding during and after operation,improve the blood coagulation function,mental state and quality of life of patients,reduce the incidence of re-bleeding after operation.