阿替普酶联合CT定位微创引流术治疗高血压脑出血的临床研究

Clinical Observation on Alteplase and CT-guided Minimally Invasive Drainage in the Treatment of Hypertensive Intracerebral Hemorrhage

目的分析阿替普酶联合CT定位微创引流手术治疗高血压脑出血的临床疗效。方法选择2014年10月—2016年10月我院神经外科收治的120例高血压脑出血病人,按随机数字法分为对照组(60例)和观察组(60例)。观察组病人采用阿替普酶联合CT定位微创引流手术治疗,对照组病人采用链激酶联合CT定位微创引流手术治疗。观察两组病人手术前后日常生活能力评分(ADL)和神经功能缺损评分(NIHSS)、出血量、颅内压变化。结果两组术后1d、3d、7d的血肿量明显低于术前;术后1d、3d、7d组间比较,观察组病人的血肿量明显低于对照组,差异有统计学意义(P<0.05)。术后,病人的颅内压有所降低,但第3天略微升高;术后1d、3d、7d组间比较,观察组病人的颅内压低于对照组,差异有统计学意义(P<0.05)。两组病人治疗后NIHSS评分、ADL评分明显优于术前;术后,观察组NIHSS评分、ADL评分明显优于对照组,差异有统计学意义(P<0.05)。观察组病人治疗总有效率为88.33%,明显高于对照组的73.33%(P<0.05)。结论阿替普酶联合CT定位微创引流手术治疗高血压脑出血病人,能提高病人血肿的清除率,减轻血肿对脑组织的损伤,提高临床疗效。

Objective To investigate the effect of alteplase and CT guided minimally invasive drainage in the treatment of hypertensiveintracerebral hemorrhage.Methods One hundred and twenty patients with hypertensive cerebral hemorrhage who were admittedto our hospital from October2014to October2016were analyzed retrospectively.They were randomly divided into two groups:controlgroup(n=60)treated with streptokinase and CT-guided minimally invasive drainage,and observation group(n=60)treated withalteplase and CT guided minimally invasive drainage.The activities of daily living(ADL),the National Institutes of Health StrokeScale(NIHSS),the amount of bleeding,intracranial pressure changes were observed.Results The volume of hematoma on1,3,7days after treatment were significantly lower than those before treatment,which was significantly lower in observation group than thatin control group(P<0.05).The intracranial pressure decreased after surgery,but increased slightly on third days after surgery.Theintracranial pressure was significantly lower in observation group than that in control group(P<0.05).The scores of NIHSS and ADLafter treatment were significantly better than before the surgery,which was significantly better in observation group than that in controlgroup(P<0.05).The total effective rate was higher in observation group than that of the control group(88.33%vs73.33%,P<0.05).ConclusionAlteplase and CT-guided minimally invasive drainage can improve the clearance rate of hematoma,reduce hematomadamage to brain tissue,improve clinical efficacy in patients with hypertensive cerebral hemorrhage.