刘宇

【摘要】 目的：比較经锁孔内镜与立体定向置管、尿激酶引流术式治疗基底节区高血压脑出血的效果及对格拉斯哥昏迷评分（GCS）和美国国立卫生研究院卒中量表评分（NIHSS）评分的影响。方法：将2018年1月-2020年6月本院收治的95例基底节区高血压脑出血患者纳入研究，根据治疗术式分为内镜组51例和联合组44例。内镜组开展经锁孔内镜术式治疗，联合组则开展立体定向置管、尿激酶引流术式治疗。分析两组各项手术指标、手术前后GCS和NIHSS评分、血清NSE及NTF-α水平，术后并发症发生情况等。结果：内镜组手术时长及术中失血量均多于联合组，而引流管留置时间少于联合组，差异均有统计学意义（P<0.05）。两组术前1 d、术后7 d GCS和NIHSS评分比较，差异均无统计学意义（P>0.05）。两组术前1 d、术后3个月血清NSE、NTF-α水平比较，差异均无统计学意义（P>0.05）。两组术后颅内感染、肺部感染、泌尿系感染、下肢深静脉血栓发生率比较，差异均无统计学意义（P>0.05）。结论：经锁孔内镜与立体定向置管、尿激酶引流术式治疗基底节区高血压脑出血的疗效相当，且对GCS和NIHSS评分的影响程度差异不明显，安全性亦无显著差异。但立体定向置管、尿激酶引流术式具有手术时间短以及术中失血量少的优势。

【关键词】 高血压脑出血 基底节区 锁孔内镜 立体定向置管 尿激酶引流术

Comparison of Effect of Keyhole Endoscopy， Stereotactic Catheterization and Urokinase Drainage in the Treatment of Hypertensive Cerebral Hemorrhage in the Basal Ganglia Region and Its Influence on GCS and NIHSS Scores/LIU Yu. //Medical Innovation of China， 2021， 18（28）： 0-056

[Abstract] Objective： To compare the effect of keyhole endoscopy， stereotactic catheterization and urokinase drainage in the treatment of hypertensive cerebral hemorrhage in the basal ganglia region and its influence on Glasgow coma scale （GCS） and national institutes of health stroke scale （NIHSS） scores. Method： A total of 95 patients with hypertensive cerebral hemorrhage in the basal ganglia region admitted to our hospital from January 2018 to June 2020 were included in the study. According to the difference of therapeutic methods， they were divided into the endoscopic group （n=51） and the combined group （n=44）. The endoscopic group was given keyhole endoscopy treatment， the combined group was given stereotactic catheterization and urokinase drainage. The operative indicators， GCS and NIHSS scores before and after operation， serum NSE and NTF-α levels before and after operation， and postoperative complications of two groups were analyzed. Result： The duration of operation and intraoperative blood loss in the endoscopic group were both higher than those of the combined group， while the duration of drainage indwelling was less than that of the combined group， the differences were statistically significant （P<0.05）. There were no significant differences in GCS and NIHSS scores between two groups at 1 d before operation and 7 d after operation （P>0.05）. There were no significant differences in the serum levels of NSE and NTF-α between two groups at 1 d before operation and 3 months after operation （P>0.05）. There were no significant differences in the incidence of intracranial infection， pulmonary infection， urinary infection and lower extremity deep venous thrombosis between two groups after operation （P>0.05）. Conclusion： The efficacy of keyhole endoscopy is comparable to that of stereotactic catheterization and urokinase drainage in the treatment of hypertensive cerebral hemorrhage in the basal ganglia region， and there are no significant differences in the degree of influence on GCS and NIHSS score and safety. However， stereotactic catheterization and urokinase drainage has the advantages of short operation time and low intraoperative blood loss.

[Key words] Hypertensive cerebral hemorrhage Basal ganglia region Keyhole endoscope Stereotactic catheterization Urokinase drainage

First-author’s address： Chaoyang City Central Hospital， Chaoyang 122000， China

doi：10.3969/j.issn.1674-4985.2021.28.013

基底节区属于临床上高血压脑出血较为常见的发病部位之一，在所有脑出血中占比超过50%，是引起患者偏瘫、吞咽障碍以及神经功能缺损的主要原因之一[1]。手术是目前国内外公认的有效治疗基底节区高血压脑出血的手段，尤其是对于血肿体积较大以及存在严重神经功能障碍的患者而言，手术治疗是一种选择[2]。……