微创双软通道引流术与尿激酶联用治疗大容积高血压脑出血的临床效果

马少彬　韩焕超　吴晖　何燕红　陈德生　黄志刚　梁艺湖　刘成金

[關键词] 高血压脑出血;锁孔开颅血肿清除术;双软通道引流术;尿激酶

[中图分类号] R743.2          [文献标识码] A          [文章编号] 1673-9701（2021）27-0021-04

Clinical effect of minimally invasive double soft channel drainage combined with urokinase in the treatment of massive hypertensive intracerebral hemorrhage

MA Shaobin1   HAN Huanchao1   WU Hui1   HE Yanhong2   CHEN Desheng1   HUANG Zhigang1   LIANG Yihu1

LIU Chengjin3

1.Department of Neurosurgery， the Fourth People′s Hospital in Nanhai District of Foshan City in Guangdong Province， Foshan   528222， China; 2.Department of Cardiovascular Medicine， the Fourth People′s Hospital in Nanhai District of Foshan City in Guangdong Province， Foshan   528222， China; 3.Department of Radiology， the Fourth People′s Hospital in Nanhai District of Foshan City in Guangdong Province， Foshan   528222， China

[Abstract] Objective To investigate the therapeutic efficacy of minimally invasive double soft channel drainage on patients with hypertensive cerebral hemorrhage. Methods A total of 79 patients with hypertensive cerebral hemorrhage with hemorrhage exceeding 60 mL admitted to our hospital from January 2018 to September 2019 were selected as the research objects， which were divided into the experimental group （n=40） and the control group （n=39） according to the random number table method. The experimental group was treated with minimally invasive double soft channel drainage， while the control group was treated with keyhole craniotomy and hematoma removal. The first hematoma clearance rate， hematoma elimination time， operation time，hospitalization time，postoperative complications， Glasgow coma scale （GCS） scores before and after operation of the two groups， Glasgow outcome scale （GOS） scores after 6 months， average hospitalization days and other data were statistically compared and analyzed. Results The first hematoma clearance rate of the experimental group was 32.50%， lower than 79.49% of the control group， with statistically significant difference after examined （P<0.05）. There was no statistically significant difference in hematoma elimination time between the two groups of patients（P>0.05）. The operation time（1.10±0.25）hours and the hospitalization time （22.1±2.12） days of the experimental group were shorter than （3.27±0.42）hours and （31.1±4.42）days of the control group， with statistically significant differences （P<0.05）. The total incidence of postoperative complications in patients of the experimental group was 45.00%， lower than 58.97% of the control group， with statistically significant difference（P<0.05）. After 1 week of operation， GCS scores of the two groups were significantly higher than those before operation， all with statistically significant difference （P<0.05）. After 1 week of operation， there was no statistically significant difference in GCS scores between the two groups（P>0.05）. There were no significant differences in mortality rate and good rate of GOS score 6 months after operation （P>0.05）. Conclusion The application of minimally invasive double soft channel drainage combined with urokinase was used to treat patients with hypertensive cerebral hemorrhage volume more than 60 mL. Meanwhile， it can quickly clear the hematoma， with less surgical trauma and fewer complications， which is worthy of promotion in grass-roots hospitals.

[Key words] Hypertensive cerebral hemorrhage; Keyhole craniotomy hematoma removal; Double soft channel drainage; Urokinase

高血压脑出血（Hypertensive intracerebral hemorrhage，HICH）是高血压患者的常见并发症，好发于基底节区，血肿形成后对周围组织的压迫可引起脑组织缺血、水肿、坏死等一系列不良反应，严重影响患者预后[1]。对于大容积HICH，不同手术方式对患者的预后起关键性作用。双软通道置入联合尿激酶冲洗引流术[2-3]与锁孔开颅术[4]的临床效果各有特点。选取2018年1月至2019年9月我院收治的血肿量超过60 mL的HICH患者79例作为研究对象，分别采用微创双软通道引流术、锁孔开颅术治疗，对比两者的疗效，现报道如下。

1 资料与方法

1.1一般资料

选取2018年1月至2019年9月我院收治的出血量超过60 mL的HICH患者79例作为研究对象，采用随机数字表法将其分为两组，其中试验组40例采用微创双软通道引流术;对照组39例采用锁孔开颅血肿清除术。根据入院时头颅CT扫描数据，采用多田氏公式计算血肿体积。两组患者性别、年龄、出血量比较，差异无统计学意义（P>0.05），具有可比性。见表1。

1.2 纳入及排除标准

1.2.1 纳入标准  ①符合高血压脑出血的诊断标准[5];②出血量大于60 mL;出血量参照多田氏公式[6]计算，即 V=S×L×π/6×slice，slice=层厚×血肿的层数，L为血肿最大层面处的最长径，S为位于该层面上与L相垂直的最大宽径;③无手术禁忌证。

1.2.2 排除标准  ①肝肾功能障碍者;②深昏迷者;③脑外伤出血者;④脑肿瘤卒中者;⑤动静脉畸形、动脉瘤、血液病等所致脑出血者[7]。……