阿替普酶在脑出血治疗中的临床观察-第三军医大学学报.DOCVIP

阿替普酶用于治疗脑出血的临床观察 刘备，陈维福(，汪峰，陈晋，程远 摘要：目的 探讨阿替普酶辅助微创术治疗高血压脑出血（HICH）的临床效果。方法 对2010年5月至2013年6月间前后两个时段，分别对采用两种溶栓药辅助微创术治疗幕上高血压脑出血患者85例进行回顾性分析。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溶栓，对两组患者治疗前后血肿量、脑水肿量、中线移位、NIHSS评分变化情况及GOS分级等进行对照分析。结果 ①阿替普酶组及尿激酶组患者脑血肿量、脑水肿量减少及NIHSS评分下降明显，中线复位显著，有统计学差异（P0.05）；②阿替普酶组与尿激酶组相比，颅内血肿清除率、血肿周围脑水肿变化率、中线复位率、GOS分级、拔管时间存在统计学差异（P0.05），而NIHSS评分、住院时间无统计学差异（P0.05）。结论 颅内血肿微创术联合溶栓药物治疗HICH是安全、有效的，阿替普酶溶栓疗效优于尿激酶。 关键词：高血压脑出血；溶栓治疗；阿替普酶；微创术 Observation the clinic effectiveness about the treatment of cerebral hemorrhage used alteplaseLiuBei，(,WangFeng，CJin，CYuan （Department of Neurosurgery，Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China） Abstract：Objective To investigate the clinic effectiveness of minimally invasive surgery(MIS)assisted with alteplase in treatment of hypertensive intracerebral hemorrhage(HICH).Methods Patients(85 cases)searched in our hospital between May 2010 and June 2013 divided into two periods,who suffered from HICH upper tentorium of cerebellum and treated with two kinds of thrombolytic drugs assisted MIS,were retrospectively analyzed and divided into the alteplase group(34 cases),urokinase group(51 cases).Of the patients at the time of admission and prior to starting treatment and at the conclusion of thrombolysis were analyzed with hematoma volume,brain edema volume,midline shift,NIHSS score and GOS grade et al.Results The hematoma volume,brain edema volume and NIHSS score decreased significantly in the two group ,the reduction in midline shift was significantly the same, there were statistically significant difference (P0.05); Compared with the urokinase group,the percent change in hematoma volume,brain edema volume,the percent reduction in midline shift , GOS grade and the time pulling out the catheter in the alteplase group were significant differences(P0.05),except for NIHSS score and duration of hospitalization (P0.05).Conclusion MIS combined with thrombolytic of HICH is a safe and effective therapy,a