吴世强 骆安林 方挺

[摘要]目的 觀察微创置管手术联合尿激酶注入治疗小脑出血的临床效果。方法 选择2016年1月～2018年12月我院收治的50例小脑出血患者作为研究对象，采用隐匿数字随机法将其分为参考组（25例）和实验组（25例）。参考组患者采用内科保守方法治疗，实验组患者采用微创置管手术联合尿激酶注入治疗。入院时、治疗后2周分别采用格拉斯哥昏迷指数（CCS）、美国国立卫生研究院卒中量表（NHISS）评价近期疗效;比较两组患者的昏迷持续时间、住院时间及并发症发生情况;患者均随访6个月，采用日常生活能力（ADL）分级评价其预后情况。结果 两组患者治疗后2周的NIHSS评分均低于入院时，GCS评分均高于入院时，差异有统计学意义（P<0.05）;实验组患者治疗后2周的NIHSS评分低于参考组，GCS评分高于参考组，差异有统计学意义（P<0.05）。两组患者的昏迷持续时间比较，差异无统计学意义（P>0.05）。实验组患者的住院时间短于参考组，并发症总发生率低于参考组，差异有统计学意义（P<0.05）。随访6个月，实验组患者的预后良好率为64.00%，高于参考组的52.00%，差异有统计学意义（P<0.05）。结论 微创置管手术联合尿激酶注入治疗小脑出血是一种简便快捷、安全有效的治疗方法。

[关键词]微创置管术;尿激酶注入;小脑出血;效果

[中图分类号] R743.34          [文献标识码] A          [文章编号] 1674-4721（2020）2（b）-0053-04

[Abstract] Objective To observe the clinical effect of minimally invasive catheterization combined with Urokinase infusion in the treatment of cerebellar hemorrhage. Methods Fifty patients with cerebellar hemorrhage admitted to our hospital from January 2016 to December 2018 were enrolled in the study， and they were divided into the reference group （n=25） and the experimental group （n=25） according to the hidden number random method. The reference group was treated with conservative medical methods， and the experimental group was treated with minimally invasive catheterization combined with Urokinase infusion. The Glasgow coma scale （GCS） and national institute of health stroke scale （NIHSS） were used to evaluate the short-term efficacy before treatment and 2 weeks after treatment. The duration of coma， hospital stay and incidence of complications were compared between the two groups. All patients were followed up for 6 months， and activity of daily living （ADL） was used to evaluate the prognosis of patients. Results The NIHSS scores at 2 weeks after treatment in the two groups were lower than those at admission， and the GCS scores were higher than those at admission， with statistically significant differences （P<0.05）. The NIHSS score at 2 weeks after treatment in the experimental group was lower than that in the reference group， and the GCS score was higher than that in the reference group， with statistically significant differences （P<0.05）. There was no significant difference in the duration of coma between the two groups （P>0.05）. The hospital stay in the experimental group was shorter than that in the reference group， and the total incidence rate of complications was lower than that in the reference group， with statistically significant differences （P<0.05）. After 6 months of follow-up， the good prognosis rate of the experimental group was 64.00%， which was higher than that of the reference group accounting for 52.00%， and the difference was statistically significant （P<0.05）. Conclusion Minimally invasive catheterization combined with Urokinase infusion for cerebellar hemorrhage is an easy， rapid， safe and effective treatment.

[Key words] Minimally invasive catheterization; Urokinase infusion; Cerebellar hemorrhage; Effect

小脑出血是神经科常见的脑出血类型，高发人群为中老年人，该病的特点是起病急，病情进展快，致残、致死率高[1]，约占脑出血的10%[2]。小脑出血部位多位于小脑半球或蚓部，出血可能压迫脑干或破入第四脑室，使后颅窝容量急剧增加导致阻塞性脑积水，颅内压进行性增高甚至出现脑疝，导致呼吸、循环突发衰竭[3-4]。血肿量>15 ml的小脑出血患者不乏保守治疗成功者，也有出血量<10 ml患者保守治疗无效死亡者，因此对于少量小脑出血的治疗方法仍存在争议。近年来文献报导微创置管手术可快速清除血肿，降低颅内压，可极大地提高成功率，降低致残率[5-6]。本研究采用微创置管手术联合尿激酶注入治疗25例小脑出血患者，并与保守治疗进行比较，对该方法应用的可行性和效果进行评价，现报道如下。

1资料与方法

1.1一般资料

选择2016年1月～2018年12月我院收治的50例小脑出血患者作为研究对象，采用隐匿数字随机法将其分为参考组（25例）和实验组（25例）。两……