微创小骨窗血肿清除术联合尿激酶溶解治疗高血压脑出血的价值探究

Value of Minimally Invasive Small Bone Window Hematoma Removal Surgery Combined with Urokinase Dissolution Therapy for Hypertensive Intracerebral Hemorrhage

目的:探讨微创小骨窗血肿清除术联合尿激酶(u-PA)溶解治疗高血压脑出血(HICH)的价值。方法:选择广宁县人民医院2018年2月—2022年2月收治的122例HICH患者作为研究对象,根据随机数表法将其分为对照组和研究组,各61例。两组均在发病24 h内进行手术,对照组给予微创小骨窗血肿清除术进行治疗,研究组在对照组的基础上联合尿激酶(u-PA)溶解治疗,术后1周比较两组的临床疗效,评估术前及术后6个月两组的神经功能及日常生活能力,统计两组的再出血率及术后并发症发生率。结果:研究组的总有效率为88.52%,高于对照组的72.13%,差异有统计学意义(P<0.05)。术后6个月,两组的美国国立卫生研究院卒中量表(NIHSS)评分均低于术前,Barthel评分高于术前,且研究组NIHSS评分低于对照组,Barthel评分高于对照组,差异有统计学意义(P<0.05)。研究组再出血率为3.28%,术后肺部感染、颅内感染等并发症发生率为6.56%,明显低于与对照组的13.11%、21.31%,差异有统计学意义(P<0.05)。结论:微创小骨窗血肿清除术联合u-PA溶解治疗HICH患者的临床效果更好,可以帮助患者恢复神经系统功能及日常生活的基本能力,减少术后出现感染及再出血等情况。

Objective:To explore the value of minimally invasive small bone window hematoma removal surgery combined with Urokinase(u-PA)dissolution therapy for hypertensive intracerebral hemorrhage(HICH).Method:A total of 122 patients with HICH admitted to Guangning County People's Hospital from February 2018 to February 2022 were selected as the study subjects.They were randomly divided into control group and study group according to the number table method,with 61 patients in each group.Both groups underwent surgery within 24 h of onset,while the control group received minimally invasive small bone window hematoma removalsurgery for treatment. The study group received a combination of u-PA dissolution therapy on the basis of the control group. The clinical efficacy of the two groups was compared at 1 week after surgery, and the neurological function and daily living ability of the two groups were evaluated before and 6 months after surgery. The incidence of rebleeding and postoperative complications in the two groups were statistically analyzed. Result: The total effective rate of the study group was 88.52%, which was higher than 72.13% of the control group, and the difference was statistically significant (P<0.05). At 6 months after surgery, the National Institutes of Health stroke scale (NIHSS) scores of both groups were lower than before surgery, and the Barthel score were higher than before surgery, and NIHSS score of the study group was lower than that in the control group, and the Barthel score was higher than that in the control group, the differences were statistically significant (P<0.05). The rebleeding rate in the study group was 3.28%, and the incidence of postoperative complications such as pulmonary infection and intracranial infection was 6.56%, significantly lower than the 13.11% and 21.31% in the control group, the differences were statistically significant (P<0.05). Conclusion: The clinical efficacy of minimally invasive small bone window hematoma removal combined with u-PA dissolution therapy for HICH patients is better, which can help patients restore nervous system function and basic abilities of daily life, reduce postoperative infections and rebleeding.