摘要
目的探讨超早期微创置管术联合尿激酶对高血压脑出血(HICH)患者血肿清除效果、炎症反应及脑血流动力学的影响。方法选择2020年1月至2021年2月我院收治的60例HICH患者作为研究对象,根据治疗方案将其分为对照组(30例,超早期微创置管术)和观察组(30例,超早期微创置管术+尿激酶)。比较两组患者的血肿清除效果、炎症指标[基质金属蛋白酶-9(MMP-9)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、脑血流动力学指标[双侧大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、左右椎动脉(VA)的血流速度]及神经功能指标[神经元特异性烯醇化酶(NSE)、脑源性神经营养因子(BDNF)、神经生长因子(NGF)]。结果术后5 h,两组的血肿残存率比较,差异无统计学意义(P>0.05);术后7、15、30 d,两组的血肿残存率均降低,且观察组明显低于对照组(P<0.05)。治疗后,两组的MMP-9、CRP、TNF-α水平均降低,且观察组明显低于对照组(P<0.05)。治疗后,两组的MCA、ACA、PCA、VA血流速度均升高,且观察组明显高于对照组(P<0.05)。治疗后,两组的NSE水平均降低,BDNF、NGF水平均升高,且观察组明显优于对照组(P<0.05)。结论超早期微创置管术联合尿激酶用于HICH患者临床治疗中,不仅可提高血肿清除效果,还能改善机体炎症反应指标及脑血流动力学指标,减轻神经功能损伤,值得临床推广应用。
Objective To explore the influences of ultra early minimally invasive catheterization combined with urokinase on hematoma clearance effect,inflammatory response and cerebral hemodynamics in patients with hypertensive intracerebral hemorrhage(HICH).Methods A total of 60 patients with HICH who were treated in our hospital from January 2020 to February 2021 were selected as the research objects,and the patients were divided into control group(30 cases,ultra early minimally invasive catheterization)and observation group(30 cases,ultra early minimally invasive catheterization+urokinase)by the treatment schemes.The hematoma clearance effect,inflammatory indexes[matrix metalloproteinase-9(MMP-9),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)],cerebral hemodynamic indexes[blood flow velocity of double middle cerebral artery(MCA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),left and right vertebral arteries(VA)]and neurological function indexes[neuron-specific enolase(NSE),brain-derived neurotrophic factor(BDNF),nerve growth factor(NGF)]were compared between the two groups.Results At 5 h after operation,there was no significant difference in the residual rate of hematoma between the two groups(P>0.05);at 7,15,and 30 d after operation,the residual rate of hematoma in both groups decreased,and that in the observation group was significantly lower than the control group(P<0.05).After treatment,the levels of MMP-9,CRP and TNF-αin both groups decreased,and those in the observation group were significantly lower than the control group(P<0.05).After treatment,the blood flow velocity of MCA,ACA,PCA and VA in the two groups increased,and those in the observation group were significantly higher than the control group(P<0.05).After treatment,the level of NSE decreased and the levels of BDNF and NSE increased in both groups,and those in the observation group were significantly better than the control group(P<0.05).Conclusion Ultra early minimally invasive catheterization combined with urokinase in the clinical treatment of HICH patients can not only improve the hematoma clearance effect,but also improve the body's inflammatory response indexes and cerebral hemodynamic indexes,and alleviate neurological damage,which is worthy of clinical promotion and application.
作者
吴彦涛
曹龙庆
杨彦平
WU Yantao;CAO Longqing;YANG Yanping(Neurosurgery Department,Gaoling District Hospital,Xi'an 710200;Neurosurgery Department,Xi'an Central Hospital,Xi'an 710003,China)
出处
《临床医学研究与实践》
2022年第22期84-87,共4页
Clinical Research and Practice
关键词
超早期微创置管术
尿激酶
高血压脑出血
血肿清除
炎症反应
脑血流动力学
ultra early minimally invasive catheterization
urokinase
hypertensive intracerebral hemorrhage
hematoma clearance
inflammatory response
cerebral hemodynamics
