阿替普酶辅助微创术治疗脑出血的临床观察

Clinical observation on the effectiveness of alteplase assisted minimally invasive surgery in the treatment of cerebral hemorrhage

目的:探讨阿替普酶辅助微创钻颅脑内血肿清除术(微创术)治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)的临床效果。方法:对我院2010年5月至2013年8月期间,采用2种溶栓药辅助微创手术治疗85例HICH病例的临床资料进行回顾性分析。其中阿替普酶组(34例)、尿激酶组(51例),微创术后给予不同溶栓药物辅助血肿溶解,对2组患者治疗前后血肿量、脑水肿量、中线移位、美国国立卫生研究院卒中量表(national institute of health stroke scale,NIHSS)评分变化及格拉斯哥预后分级(Glasgow outcome scale,GOS)进行对照分析。结果:1阿替普酶组及尿激酶组血肿量(t=13.765,P=0.000;t=19.404,P=0.000)、脑水肿量(t=7.691,P=0.000;t=10.872,P=0.000)及NIHSS评分(t=8.600,P=0.000;t=11.991,P=0.000)均较术前明显下降,中线复位明显(t=8.796,P=0.000;t=10.322,P=0.000),有统计学差异;2阿替普酶组与尿激酶组相比,血肿清除率(χ2=3.026,P=0.003)、脑水肿变化率(χ2=2.267,P=0.026)、中线复位率(χ2=2.549,P=0.013)、GOS(t=2.066,P=0.043)、拔管时间(t=-2.397,P=0.019)存在统计学差异,而NIHSS评分(t=1.866,P=0.068)、住院时间(t=-0.903,P=0.371)无统计学差异。结论:溶栓药物辅助微创术治疗HICH是安全的、有效的,阿替普酶血肿溶解疗效优于尿激酶。

Objective：To investigate the clinic effectiveness of minimally invasive surgery（MIS）assisted alteplase in the treatment of hypertensive intracerebral hemorrhage（HICH）. Methods：Totally 85 patients admitted in our hospital between May 2010 to August2013,who suffered from HICH and treated with two kinds of thrombolytic drugs assisted with MIS were retrospectively analyzed and divided into the alteplase group（n =34） and urokinase group（n =51）.Hematoma volume,brain edema volume,midline shift,National Institute of Health Stroke Scale（NIHSS）and Glasgow Outcome Scale（GOS）scores were analyzed and compared. Results：1hematoma volume（t =13.765,P =0.000;t =19.404,P =0.000）,brain edema volume（t =7.691,P =0.000;t =10.872,P =0.000） and NIHSS score（t =8.600,P=0.000;t=11.991,P=0.000）were decreased significantly in two groups and midline shift（t=8.796,P=0.000;t=10.322,P=0.000）was obvious,with statistical differences. 2There was no statistical differences in hematoma volume（χ2=3.026,P=0.003）,brain edema volume（χ2=2.267,P=0.026）,midline shift rate（χ2=2.549,P=0.013）,GOS score（t=2.066,P=0.043）and catheter-drawing time（t=-2.397,P=0.019）between urokinase group and alteplase group while there was no statistical difference in NIHSS score（t=1.866,P =0.068） and hospitalization duration（t =-0.903,P =0.371） between the two groups. Conclusion：MIS combined with thrombolytsis is safe and effective in the treatment of HICH and the efficacy of alteplase is better than urokinase.