不同剂量尿激酶对脑内血肿溶解引流效果的影响

发布时间：2018-07-10 08:59

本文选题：尿激酶 + 脑出血　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:观察不同剂量(大剂量5万u/次,中剂量3万u/次,小剂量1万u/次)尿激酶对脑出血微创置管术后患者脑内血肿溶解引流的效果、临床疗效、安全性的影响,进行统计学分析,进行对比研究,探讨合适剂量,以保证疗效,避免浪费,减少可能的副作用,并对临床现象作出相应机制推测。方法:选择行脑内血肿微创置管术的脑出血病人66例,所有患者符合《中华人民共和国卫生行业标准:成人自发性脑出血诊断标准(WS320-2010)》,并制定排除标准,以剔除可能对结果有干扰的病例。所有入选患者脑内血肿量在35~50ml之间,自发病开始至应用尿激酶时间在10-14小时之间。根据尿激酶给予剂量,将患者随机分为三组,A组(22人)给予尿激酶1万u+生理盐水5ml溶解后脑内引流管注入;B组(22人)给予尿激酶3万u+生理盐水5ml溶解后脑内引流管注入;C组(22人)给予尿激酶5万u+生理盐水5ml溶解后脑内引流管注入。以上三组患者均在尿激酶注入后夹闭引流管,2小时后放开,每8小时注入一次尿激酶,共注入6次。注意防治并发症。所有患者术后立即复查CT检查,注射6次尿激酶后再次复查CT,多田公式计算血肿体积,然后计算出血肿清除率,血肿清除率=(术后注射尿激酶前血肿体积-注射尿激酶6次后血肿体积)/术后注射尿激酶前血肿体积,术后常规止血、应用抗生素、脱水、保护脑细胞、预防应激性溃疡、支持营养等治疗,对比分析三组患者注射6次尿激酶后脑内血肿清除率、术后第14天致残MRS评分、术后14天GCS评分等指标。结果:在脑出血患者行脑内血肿置管引流术治疗中,从临床疗效看,尿激酶1万u组(A组)、3万u组(B组)、5万u组(C组)任意两组脑内血肿清除率、术后第14天致残MRS评分等、术后14天GCS评分比较差异无统计学差异(P0.05),从术后并发症看,3组患者术后肺部感染、上消化道出血数据比较差异无统计学意义(P0.05),但A、B组癫痫发生率分别与C组相比较差异有统计学意义(P0.05),A、B组之间比较差异无统计学意义(P0.05),A、B组癫痫发病率要明显小于C组。结论:在脑出血患者行脑内血肿置管引流术治疗中,应用尿激酶可以促进血肿溶解排出,减少血肿毒性和占位效应。应用尿激酶1万u、3万u、5万u这三种不同剂量组取得的临床效果相似,从脑内血肿清除率、术后第14天致残MRS评分等、术后14天GCS评分这几个指标看,数据对比差异不明显,无统计学意义。癫痫术后发生率5万u组明显较其余两组高。在本研究中,不同剂量尿激酶在本试验中对脑内血肿引流效果无明显差异,小剂量尿激酶疗效未见降低,而副作用少,值得临床中推广应用。
[Abstract]:Objective: to observe the effect of urokinase (urokinase) at different doses (large dose 50 000 u / time, middle dose 30 000 u / time, low dose 10 000 u / time) on intracerebral hematoma dissolution and drainage after minimally invasive catheterization in patients with intracerebral hemorrhage (ICH). Statistical analysis and comparative study were carried out in order to ensure the curative effect, avoid waste, reduce possible side effects, and speculate on the mechanism of clinical phenomena. Methods: 66 patients with intracerebral hemorrhage underwent minimally invasive catheterization of intracerebral hematoma were selected. All the patients were in accordance with the Standard of Health Industry of the people's Republic of China: diagnostic criteria of Adult spontaneous Cerebral Hemorrhage (WS320-2010), and the exclusion criteria were established. To eliminate cases that may interfere with the outcome. The amount of intracerebral hematoma in all patients was between 35~50ml and urokinase between 10-14 hours. According to the dose of urokinase, The patients were randomly divided into three groups (n = 22): group A (n = 22) received urokinase 10,000 u normal saline (5ml) dissolution and intracerebral drainage tube injection (n = 22). Group B (n = 22) received urokinase 30,000 u saline 5ml dissolution and intracerebral drainage tube injection (n = 22). The brain drainage tube was injected with urokinase 50 000 u normal saline 5ml dissolution. All the patients in the above three groups were injected with urokinase for 6 times every 8 hours after the drainage tube was clamped and closed for 2 hours. Pay attention to prevention and treatment of complications. All the patients were examined by CT immediately after operation. After 6 injections of urokinase, the volume of hematoma was calculated by Duotian formula, and the clearance rate of hematoma was calculated. Hematoma clearance rate = (hematoma volume before injection of urokinase-hematoma volume after injection of urokinase 6 times) / hematoma volume before injection of urokinase, routine hemostasis after operation, application of antibiotics, dehydration, protection of brain cells, prevention of stress ulcer, The clearance rate of intracerebral hematoma after 6 injections of urokinase was compared and analyzed. The scores of Mrs on the 14th day and GCS on the 14th day after operation were compared and analyzed. Results: in the treatment of intracerebral hemorrhage patients with intracerebral hematoma catheterization, the clinical efficacy of urokinase 10,000 u group (A group), 30 000 u group (B group), 50 000 u group (C group) any two groups of intracerebral hematoma clearance rate, 14 days after the disabled Mrs score, etc. There was no significant difference in GCS score 14 days after operation (P0.05). There was no significant difference in the data of upper gastrointestinal hemorrhage (P0.05), but the incidence of epilepsy in group A B was significantly lower than that in group C (P0.05). There was no significant difference between group A and group B (P0.05) the incidence of epilepsy in group A was significantly lower than that in group C (P0.05). Conclusion: urokinase can promote hematoma dissolution and discharge and reduce hematoma toxicity and space occupying effect in intracerebral hemorrhage patients treated by intracerebral hematoma catheterization and drainage. The clinical effects of urokinase at different doses of 10,000 u, 30,000 u and 50,000 u were similar. From the clearance rate of intracerebral hematoma, the score of disabling Mrs on the 14th day after operation, and the score of GCS on the 14th day after operation, there was no significant difference in the data. There is no statistical significance. The incidence of epilepsy in the 50 000 u group was significantly higher than that in the other two groups. In this study, there was no significant difference in the effect of different doses of urokinase on the drainage of intracerebral hematoma. The curative effect of low dose urokinase was not decreased, but the side effect was less, so it is worth popularizing in clinic.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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