早期应用水蛭素治疗脑出血的临床研究

Clinical research of early application of hirudin therapy on cerebral hemorrhage

目的观察水蛭素注射液对自发性脑出血血肿吸收、血肿周围低密度区改变及对神经功能恢复的影响。方法将425例入选的自发性脑出血患者随机分为治疗组308例和对照组117例。治疗组给予水蛭素注射液6ml加入5%葡萄糖液250ml中静脉滴注,每日1次。分别于治疗前和治疗后4、10、21天利用CT测量血肿体积及血肿周围低密度区,采用欧洲卒中量表进行神经功能缺损评分。结果治疗组第10、21天血肿体积均明显低于对照组,(21±10)mlvs(27±8)ml,(14±7)mlvs(25±9)ml(P<0.01);治疗组21天时血肿周围低密度区小于对照组,(1.5±0.4)mmvs(3.0±0.7)mm(P<0.01);治疗组第10、21天欧洲卒中量表神经功能缺损评分(ESS)均明显高于对照组,(62±19)分vs(46±16)分、(66±24)分vs(51±14)分(P<0.01)。结论早期应用水蛭素注射液能促进脑出血血肿的吸收,使血肿周围低密度区缩小和促进神经功能恢复。

Objective To investigate the effects of hirudin on absorption of intracerebral hematoma,changes of low density area surrounding hematoma,and recovery of neurological function in patients with spontaneous intracerebral hemorrhage.Methods 425 patients with spontaneous intracerebral hemorrhage were randomly divided into treatment group and control group,308 cases and 117 cases respectively.The patients in treatment group were intravenously given the mixture of hirudin solution 6 ml and 5% glucose 250 ml once daily.The volume of hematoma and low density area around hematoma were measured by CT before and after treatment at 4,10 and 21 days,the neurological function was scored by the European Stroke Scale.Results Hematoma volume in the treatment group was significantly smaller than that in the control group at the 10 th and 21 th day respectively,（21±10） ml vs （27±8） ml,（14±7） ml vs （25±9） ml（P〈0.01）.The low density area around hematoma in the treatment group was significantly smaller than that in the control group,（1.5±0.4） mm vs （3.0±0.7） mm（P〈0.01）.The neurological function score in the treatment group was significantly higher than that in the control group at 10th and 21st day respectively,（62±19） fractions vs （46±16） fractions,（66±24） fractions vs （51±14） fractions （P〈0.01）.Conclusion Early administration of hirudin can enhance absorption of hematoma,reduce low density area surrounding hematoma and alleviate nervous function in patients with spontaneous intracerebral hemorrhage.