立体定向联合尿激酶治疗脑出血的疗效分析

目的对比立体定向联合尿激酶治疗与单纯药物治疗后脑出血后患者血肿周围水肿(Perihematomal edema,PHE)程度及近期疗效。方法回顾性分析2015年1月至2019年6月湖南师范大学附属张家界医院行立体定向联合尿激酶治疗或单纯药物治疗的96名患者的临床病例资料。采用倾向性评分匹配法以1∶1的比例对患者进行匹配,匹配变量包括年龄、性别、是否破入脑室、ICH评分、GCS评分、基线血肿体积、基线血糖、基线收缩压及基线舒张压。最终将完成立体定向微创引流术联合尿激酶治疗(立体定向组)与单纯药物治疗(药物治疗组)的各28例患者纳入本研究。结果两组均无治疗期间死亡病例。水肿延伸距离(Edema extension distance,EED)、血肿体积、血肿及水肿总体积随时间变化显著,差异有统计学意义(P 0. 05),血肿体积及总体积的组别与测量时间的交互作用显著,差异有统计学意义(P 0. 05),两组EED在入院时,治疗后第1天,治疗后第3天相似(P 0. 05),治疗后第3天立体定向组EED大于药物治疗组,但差异无统计学意义。立体定向组血肿体积在治疗后第1天,治疗后第3天及治疗后第7天显著少于药物治疗组(P 0. 01),且立体定向组总体积在第1天及第3天也小于药物治疗组(P 0. 01),差异有统计学意义。两组治疗后1月(Activities of daily living) ADL评分与1月m RS评分相似(P 0. 05),差异无统计学意义。结论立体定向微创引流术联合尿激酶治疗与单纯药物治疗相比虽能明显减轻占位效应,但可能不能改善PHE及近期功能预后。

Clinical effect of stereotactic therapy combined with urokinase in treatment of cerebral hemorrhage

Objective To investigate the degree and short-term outcome of perihematomal edema (PHE) after intracerebral hemorrhage following stereotactic therapy combined with urokinase versus medication alone.Methods A retrospective analysis was performed for the clinical data of 96 patients who received stereotactic therapy combined with urokinase or medication alone in Zhangjiajie Hospital of Hunan Normal University from January 2015 to June 2019. The patients were matched at a ratio of 1:1 using the propensity score matching method, and the matching variables included age, sex, whether it broke into the ventricle, ICH score, GCS score, baseline hematoma volume, baseline blood glucose, baseline systolic pressure, and baseline diastolic pressure. Finally, 28 patients who completed minimally invasive stereotactic drainage combined with urokinase were enrolled as stereotactic group and 28 patients who received medication alone were enrolled as medication group.Results There were no deaths during treatment in the two groups. Edema extension distance (EED), hematoma volume, and total volume of hematoma and edema changed significantly with time (P<0.05), and there was a significant interaction between group and time of measurement for hematoma volume and total volume (P<0.05). The two groups had a similar EED on admission and on days 1 and 3 after treatment (P>0.05), and the stereotactic group had a non-significantly larger EED than the medication group on day 3 after treatment. The stereotactic group had a significantly lower volume of hematoma than the medication group on days 1, 3, and 7 after treatment (P<0.01), and the stereotactic group had a significantly lower total volume than the medication group on days 1 and 3 after treatment (P<0.01). The two groups had similar ADL and mRS scores at 1 month after treatment (P>0.05).Conclusions Compared with medication alone, although minimally invasive stereotactic drainage combined with urokinase can significantly reduce the mass effect, it may not improve PHE and short-term functional prognosis.