颅骨钻孔尿激酶溶解引流术治疗脑出血的疗效分析

Clinical efficacy analysis of cranial drilling and urokinase dissolve drainage in the treatment of cerebral hemorrhage

目的比较颅骨钻孔尿激酶溶解穿刺引流术与小骨窗开颅血肿清除术治疗高血压脑出血的临床疗效。方法86例高血压脑出血随机分为小骨窗开颅血肿清除术组(A组)及颅骨钻孔尿激酶溶解穿刺引流术组(B组),其中A组在全麻下,采用显微器械在显微镜直视下行颅内血肿清除。B组在局麻下,借助脑穿针放置引流管于血肿中,再辅以尿激酶溶解血肿。比较2组患者手术时间、住院时间、术后再出血及术后并发症、术后近期及远期疗效等。结果 A组手术及住院时间明显长于B组(P<0.05),A组血肿清除率明显好于B组;2组术后均并发肺部感染、消化道出血等,差异无统计学意义(P>0.05)。A组术后1月神经功能缺失程度明显重于B组(P<0.05),术后6月2组患者日常生活能力Barthel评分差异无统计学意义(P>0.05)。结论颅骨钻孔尿激酶穿刺引流术手术操作简便,住院时间短,短期内患者神经功能恢复好。

Objective To compare clinical efficacy of cranial drilling and urokinase dissolve drainage versus small bone window craniotomy in patients with hypertensive cerebral hemorrhage .Methods 86 cases of hypertensive cerebral hemorrhage were randomly divided into small bone window craniotomy group （group A） and cranial drilling and urokinase dissolve drainage group （group B） .Patients in group A under general anesthesia ,we evacuated the hematoma using microsurgical instruments under direct vision .Patients in group B under local anesthesia ,we placed the drainage tube into the hematoma with the help of brain needle ,then dissolved hematoma supplemented by urokinase .Operation time ,hospitalization stay ,postoperative bleeding and postoperative complications ,the recent and long‐term curative effect after operation of two groups were observed and com‐pared in two groups .Results The operation time and hospital stay of group A were significantly longer than that of group B （P〈0 .05）;The hematoma clearance rate of group A was obviously better than that of group B （P〈0 .05）;Although patients in two groups complicated with lung infection and gastrointestinal bleeding ,there was no statistical difference between the two groups （P＆gt;0 .05） .After 1‐month operation ,patients in group A had severer nerve function defect degree than those in group B （P〈0 .05）;in addition ,the Barthel scores of daily life ability of two groups showed no significant difference after 6‐month operation（P＆gt;0 .05） .Conclusion Cranial drilling and urokinase dissolve drainage operation is simply feasible with shorter hos‐pitalization stay and better short‐term neural functional recovery .