方体定向置软管血肿排空术联合醒脑静救治重型高血压性脑出血的临床观察
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摘要
目的：观察方体定向置软管血肿排空术联合醒脑静救治重型高血压性脑出血临床疗效。
方法：选取吉林大学白求恩第一医院符合临床诊断标准的45例患者，随机分为对照组、治疗组，对照组采用方体定向置软管血肿排空术治疗脑出血，治疗组在对照组基础上加用醒脑静注射液20ml入5%葡萄糖或0.9%氯化钠注射液500ml中静滴,每日1次。观察各组在有效率、死亡率、昏迷时间、并发症例数、脑血肿消除时间及临床综合疗效，进行对照研究。
结果：经治疗后，两组有效率、死亡率比较无明显差别，然而两组在缩短昏迷时间、减少并发症例数、缩短脑血肿消除时间、临床综合疗效上比较均有明显差别，治疗组均优于对照组（P<0.05）。
结论：两组在有效率、死亡率上无明显差异,但在缩短昏迷时间、减少并发症例数、缩短脑血肿消除时间、临床综合疗效方面,方体定向置软管血肿排空术联合醒脑静救治重型高血压性脑出血临床疗效明显优于对照组。
Objective: To observe the cube orientation set hose the hematoma emptying surgeryXingnaojing treat severe hypertensive intracerebral hemorrhage clinical efficacy.
Methods: Bethune First Hospital of Jilin University of clinical diagnostic criteria in45patients, randomized into control group, treatment group and control group directed set ofcube hose the hematoma emptying the treatment of cerebral hemorrhage, the treatment groupin the control group on the basis of add20ml into XNJI5%glucose or normal salineintravenous infusion in500ml,1time a day. Observed in each group in an efficient, mortality,duration of coma, complications, number of cases, brain hematoma eliminate and clinicalefficacy, were studied as controls.
Results: After treatment，Two sets of efficiency、mortality was no significant difference，However, two groups, there were significant differences in clinical effects in shortening theduration of coma, reduce complications in the number of cases, shorten the elimination of brain hematoma,Treatment group than the control group (P <0.05).
Conclusion: The two efficiency, no significant difference in mortality, However, toshorten the duration of coma, reduce the number of complications in patients, to reduce brainhematoma to eliminate time and clinical effects, side body directional set hose hematomaemptying combined with Xingnaojing treatment of severe hypertensive cerebral hemorrhagewere significantly better than the control group.
方法：选取吉林大学白求恩第一医院符合临床诊断标准的45例患者，随机分为对照组、治疗组，对照组采用方体定向置软管血肿排空术治疗脑出血，治疗组在对照组基础上加用醒脑静注射液20ml入5%葡萄糖或0.9%氯化钠注射液500ml中静滴,每日1次。观察各组在有效率、死亡率、昏迷时间、并发症例数、脑血肿消除时间及临床综合疗效，进行对照研究。
结果：经治疗后，两组有效率、死亡率比较无明显差别，然而两组在缩短昏迷时间、减少并发症例数、缩短脑血肿消除时间、临床综合疗效上比较均有明显差别，治疗组均优于对照组（P<0.05）。
结论：两组在有效率、死亡率上无明显差异,但在缩短昏迷时间、减少并发症例数、缩短脑血肿消除时间、临床综合疗效方面,方体定向置软管血肿排空术联合醒脑静救治重型高血压性脑出血临床疗效明显优于对照组。
Objective: To observe the cube orientation set hose the hematoma emptying surgeryXingnaojing treat severe hypertensive intracerebral hemorrhage clinical efficacy.
Methods: Bethune First Hospital of Jilin University of clinical diagnostic criteria in45patients, randomized into control group, treatment group and control group directed set ofcube hose the hematoma emptying the treatment of cerebral hemorrhage, the treatment groupin the control group on the basis of add20ml into XNJI5%glucose or normal salineintravenous infusion in500ml,1time a day. Observed in each group in an efficient, mortality,duration of coma, complications, number of cases, brain hematoma eliminate and clinicalefficacy, were studied as controls.
Results: After treatment，Two sets of efficiency、mortality was no significant difference，However, two groups, there were significant differences in clinical effects in shortening theduration of coma, reduce complications in the number of cases, shorten the elimination of brain hematoma,Treatment group than the control group (P <0.05).
Conclusion: The two efficiency, no significant difference in mortality, However, toshorten the duration of coma, reduce the number of complications in patients, to reduce brainhematoma to eliminate time and clinical effects, side body directional set hose hematomaemptying combined with Xingnaojing treatment of severe hypertensive cerebral hemorrhagewere significantly better than the control group.
引文
[1]杨期东,周艳宏,王文志,等．中国3个城市社区人群脑卒中死亡及其类型分布特征[J]．中华老年心脑血管病杂志,2003,5：3942．
[2] J Zhang LF,Yang J,hongZ,et a／． Proportion ofdiferent subtypesofstroke in China[J]．Stroke,2003,34：2091-2096．
[3]王文志．脑血管病的流行病学[A]．见：粟秀初,孔繁元,范学文．现代脑血管病学[M]．北京：人民军医出版社,2003．1lll8．
[4]刘红梅,王文志,李涤,微创穿刺术与小骨窗开颅术治疗脑出血的随机对照研究,中华老年脑血管病杂志2007年3月第9卷第3期Chin J GeriatrHeart Brainv Dis, Mar2007,Vol9,No．3
[5] QureshiA I, TuhrimS, BroderickJP, Batjerhh, H ondoh, Hanley DRS Pontaneous intracerebra l hemorrhage. NEngl JM ed,2001,344:14501460.
[6]邓平,吴晓牧.高血压性脑出血病理生理机制研究进展,中华脑血管病杂志(电子版)2010年8月第4卷第4期C hin JC erebrovasc D is (E lectronic Ed ition), Augu st2010,Vol4, No.4267
[7] Quresh iA I, Tuhrim S, B roderick JP, et a.l pontaneous in tracerebra l hemo rrhage. N Engl JM ed,2001,344:14501460.
[8] M ayer SA, U ltra early hemostat ic theraoy for intraecrebra l hemorrhage. Stroke,2003,34:224229.
[9] M aurino J, H ypo thesis of intracerebral hemorrhage g row th. Stroke,2003,34:78.
[10] Hua Y, X iG, Keep RF, e t a.l complement activation in the bra in after experimentalhemorrhage. J N eurosurg,2000,92:1016.中华脑血管病杂志(电子版)2010年8月第4卷第4期ChinJCerebrovascDis(ElectronicEdition),August2010,Vol4,No.4277
[11] K idw e ll CS, Saver JL, M att iello, et a.l D iffusion PerfusionMR evaluat ion ofPerihematoma l injury in hyperacutein tracerebra l hemo rrhage, Neuro logy,2001,57:16111617.
[12] XueM, D el B ig io MR, Intracortica l hemorrhage injury in rats: re lationship bu tw eenb lood fract ions and bra ince ll death. S troke,2000,31:17211727.
[13]王景周,周中和,李玮,等.大鼠脑出血血肿周边组织细胞凋亡的动态变化规律研究。中国临床神经科学,2003,11:124127.
[14]史玉泉等,脑血管疾病,实用神经病学,第二版2000,3；645646.
[15]刘金龙等,高血压性脑出血的外科治疗进展,立体定向和功能性神经外科杂志2006年第19卷第6期Chin J Stereotact Funct Neurosurg,Dec.2006,Vol.19,No.6379
[16]王家文,靳红心,孙政.高血压性脑出血影响手术预后的原因分析[J].安徽医学,2000,21(5):50～51.
[17]张铁岩.高血压性脑出血外科手术治疗脑病分析[J].白求恩医科大学学报,2000,26(3):86.
[18]李坚.外科手术治疗高血压性脑出血的现状及进展[J].医学文选,2005,24(1):130～132.
[19] ZiaiWC, Port JD, Cowan JA, et al. Decomp ressive craniectomy forintractable cerebraledema: experience of a single center [J]. JNeurosurg Anesthesiol,2003,15(1):25232.
[20] Schaller B, Graf R, Sanada Y, et al. Hemodynamic and metaboliceffects ofdecompressive hemicraniectomy in normal brain. An exper2imental PET2study incats[J]. Brain Res,2003,982(1):31237.
[21] Prasad K,Browan G, Srivastava A, et al. Surgery in p rimary sup rat2医学综述2009年11月第15卷第21期Medical Recap itulate,Nov2009,Vol.15,No.21·3265·entorialintracerebral hematoma: a meta2analysis of randomizedtrials[J]. Acta Neurol Scand,1997,95(2):1032110.
[22]孙秀海,张振兴. CT定向钻孔引流术与传统开颅术治疗高血压性脑出血448例对比观察[J].山东医药,2005,45(15):41242.
[23]杨李轩,黄权,胡裕全,等.高血压性脑出血显微外科手术治疗效果[J].中华显微外科杂志,2002,25(1):23224.
[24]杨应明.高血压性脑出血脑内血肿致病特点与手术对策[J].中华神经医学杂志,2003,2(3):1772179.
[25]李云辉,林中平,黄建龙,等.超早期锁孔血肿清除术治疗高血压基底节出血24例
[J].中国危重病急救医学,2005,17(5):312.
[26] Auer LM,DeinsbergerW, Niederkorn K, et al. Endoscop ic surgeryversus medicaltreatment for spontaneous intracerebral hematoma: arandomized study[J]. J Neurosurg,1989,70(4):5302535.
[27]查韡光,付相平,李安民,等. CT引导立体定向神经内镜手术治疗高血压性脑出血[J].中国临床神经外科杂志,2006,11(5):2852287.
[28]洪远,张茂,干建新,等.急诊科开展神经内镜治疗自发性脑出血的可行性探讨[J].中国急救医学,2005,25(11):7932795.
[29]梁玉敏,赵明珠,刘卫东,等.神经导航辅助微创治疗高血压性脑出血[J].中华医药学杂志,2003,2(6):728.
[30] Backlund EO, von holst h. Controlled subtotal evacuation ofintracerebral haematomas bystereotactic technique [J]. Surg Neu2rol,1978,9(2):992101.
[31] Teernstra OP, Evers SM, Lodder J, et al. Stereotactic treatment ofintracerebral hematomabymeans of a p lasminogen activator: amul2ticenter randomized controlled trial(SICHPA)[J]. Stroke,2003,34(4):9682974.
[32] N INDS ICH WorksHop Participants. Priorities for clinical researchin intracerebralhemorrhage: report from a National Institute ofNeurological Disorders and StrokeWorks Hop [J]. Stroke,2005,36(3):23241.
[33] Naff NJ, Carhuapoma JR,WilliamsMA, et al. Treatment of intra2ventricular hemorrhagewith urokinase: effects on302day surviva1[J]. Stroke,2000,31(4):8412847.
[34]杜建新,凌锋,谌燕飞,等.小骨窗开颅术和钻孔引流术治疗脑出血疗效的对比研究
[J].中国脑血管病杂志,2004,1(7):2922294.
[35]骆锦标1,孙树杰2,彭彪1,曹志凯1,全伟1,肖国才1,吕建平1,罗东东1,崔明2,方体定向置软管血肿排空术与开颅术救治重型高血压性脑出血的比较分析,大连医科大学学报,第31卷第4期2009年8月Vol.31No.4Aug.2009
[36]衡先培.中西医结合防治糖尿病动脉硬化的思路与方法[J].中国中西医结合杂志,2007,27(8):679.
[37]韦广莹,李晶.醒脑静治疗脑出血60例临床观察[J].山西临床医药实践旬刊,2009,35(12)
[38] Sun SJ, Zou RL, Liu X, et a.l Aspirating serious hyperten-sive intracerebral hematomabyminimally invasive tube in-sertion [J]. Chin J EmergMed,2002,11(5):295-297.
[39]孙树杰,刘欣,聂志余,等.微创置管吸引术治疗高血压性脑出血[J].急诊医学,2002,4:84-87.
[40] PiotrowskiWP,RochowanskiE. Operative results in hyper-tensive intracerebralhaematomas in patients over60[J].Gerontoogy,1996,42:339-347.
[41]骆锦标,孙树杰,彭彪,等,方体定向置软管血肿排空术与开颅术救治重型高血压性脑出血的比较分析[J].大连医科大学学报,2009,(4)
[42] PiotrowskiWP,RochowanskiE. Operative results in hyper-tensive intracerebralhaematomas in patients over60[J].Gerontoogy,1996,42:339-347.
[43] TzaanWC, Lee ST, Lui TN. Combined use of stereotacticaspiration and intracerebralstreptokinase infusion in thesurgical treatment of hypertensive intracerebral hemorrhage[J]. J FormosMed Assoc,1997,96:962-967.
[44]屈松柏,李家庚.实用中医心血管病学[M].第1版.北京:科学技术文献出版社,1993:605-607.
[45]张建军,董伟峰,顾水均,等.高血压性脑出血外科治疗近期预后因素临床分析[J].中国危重病急救医学,2005,17(5):311-312
[2] J Zhang LF,Yang J,hongZ,et a／． Proportion ofdiferent subtypesofstroke in China[J]．Stroke,2003,34：2091-2096．
[3]王文志．脑血管病的流行病学[A]．见：粟秀初,孔繁元,范学文．现代脑血管病学[M]．北京：人民军医出版社,2003．1lll8．
[4]刘红梅,王文志,李涤,微创穿刺术与小骨窗开颅术治疗脑出血的随机对照研究,中华老年脑血管病杂志2007年3月第9卷第3期Chin J GeriatrHeart Brainv Dis, Mar2007,Vol9,No．3
[5] QureshiA I, TuhrimS, BroderickJP, Batjerhh, H ondoh, Hanley DRS Pontaneous intracerebra l hemorrhage. NEngl JM ed,2001,344:14501460.
[6]邓平,吴晓牧.高血压性脑出血病理生理机制研究进展,中华脑血管病杂志(电子版)2010年8月第4卷第4期C hin JC erebrovasc D is (E lectronic Ed ition), Augu st2010,Vol4, No.4267
[7] Quresh iA I, Tuhrim S, B roderick JP, et a.l pontaneous in tracerebra l hemo rrhage. N Engl JM ed,2001,344:14501460.
[8] M ayer SA, U ltra early hemostat ic theraoy for intraecrebra l hemorrhage. Stroke,2003,34:224229.
[9] M aurino J, H ypo thesis of intracerebral hemorrhage g row th. Stroke,2003,34:78.
[10] Hua Y, X iG, Keep RF, e t a.l complement activation in the bra in after experimentalhemorrhage. J N eurosurg,2000,92:1016.中华脑血管病杂志(电子版)2010年8月第4卷第4期ChinJCerebrovascDis(ElectronicEdition),August2010,Vol4,No.4277
[11] K idw e ll CS, Saver JL, M att iello, et a.l D iffusion PerfusionMR evaluat ion ofPerihematoma l injury in hyperacutein tracerebra l hemo rrhage, Neuro logy,2001,57:16111617.
[12] XueM, D el B ig io MR, Intracortica l hemorrhage injury in rats: re lationship bu tw eenb lood fract ions and bra ince ll death. S troke,2000,31:17211727.
[13]王景周,周中和,李玮,等.大鼠脑出血血肿周边组织细胞凋亡的动态变化规律研究。中国临床神经科学,2003,11:124127.
[14]史玉泉等,脑血管疾病,实用神经病学,第二版2000,3；645646.
[15]刘金龙等,高血压性脑出血的外科治疗进展,立体定向和功能性神经外科杂志2006年第19卷第6期Chin J Stereotact Funct Neurosurg,Dec.2006,Vol.19,No.6379
[16]王家文,靳红心,孙政.高血压性脑出血影响手术预后的原因分析[J].安徽医学,2000,21(5):50～51.
[17]张铁岩.高血压性脑出血外科手术治疗脑病分析[J].白求恩医科大学学报,2000,26(3):86.
[18]李坚.外科手术治疗高血压性脑出血的现状及进展[J].医学文选,2005,24(1):130～132.
[19] ZiaiWC, Port JD, Cowan JA, et al. Decomp ressive craniectomy forintractable cerebraledema: experience of a single center [J]. JNeurosurg Anesthesiol,2003,15(1):25232.
[20] Schaller B, Graf R, Sanada Y, et al. Hemodynamic and metaboliceffects ofdecompressive hemicraniectomy in normal brain. An exper2imental PET2study incats[J]. Brain Res,2003,982(1):31237.
[21] Prasad K,Browan G, Srivastava A, et al. Surgery in p rimary sup rat2医学综述2009年11月第15卷第21期Medical Recap itulate,Nov2009,Vol.15,No.21·3265·entorialintracerebral hematoma: a meta2analysis of randomizedtrials[J]. Acta Neurol Scand,1997,95(2):1032110.
[22]孙秀海,张振兴. CT定向钻孔引流术与传统开颅术治疗高血压性脑出血448例对比观察[J].山东医药,2005,45(15):41242.
[23]杨李轩,黄权,胡裕全,等.高血压性脑出血显微外科手术治疗效果[J].中华显微外科杂志,2002,25(1):23224.
[24]杨应明.高血压性脑出血脑内血肿致病特点与手术对策[J].中华神经医学杂志,2003,2(3):1772179.
[25]李云辉,林中平,黄建龙,等.超早期锁孔血肿清除术治疗高血压基底节出血24例
[J].中国危重病急救医学,2005,17(5):312.
[26] Auer LM,DeinsbergerW, Niederkorn K, et al. Endoscop ic surgeryversus medicaltreatment for spontaneous intracerebral hematoma: arandomized study[J]. J Neurosurg,1989,70(4):5302535.
[27]查韡光,付相平,李安民,等. CT引导立体定向神经内镜手术治疗高血压性脑出血[J].中国临床神经外科杂志,2006,11(5):2852287.
[28]洪远,张茂,干建新,等.急诊科开展神经内镜治疗自发性脑出血的可行性探讨[J].中国急救医学,2005,25(11):7932795.
[29]梁玉敏,赵明珠,刘卫东,等.神经导航辅助微创治疗高血压性脑出血[J].中华医药学杂志,2003,2(6):728.
[30] Backlund EO, von holst h. Controlled subtotal evacuation ofintracerebral haematomas bystereotactic technique [J]. Surg Neu2rol,1978,9(2):992101.
[31] Teernstra OP, Evers SM, Lodder J, et al. Stereotactic treatment ofintracerebral hematomabymeans of a p lasminogen activator: amul2ticenter randomized controlled trial(SICHPA)[J]. Stroke,2003,34(4):9682974.
[32] N INDS ICH WorksHop Participants. Priorities for clinical researchin intracerebralhemorrhage: report from a National Institute ofNeurological Disorders and StrokeWorks Hop [J]. Stroke,2005,36(3):23241.
[33] Naff NJ, Carhuapoma JR,WilliamsMA, et al. Treatment of intra2ventricular hemorrhagewith urokinase: effects on302day surviva1[J]. Stroke,2000,31(4):8412847.
[34]杜建新,凌锋,谌燕飞,等.小骨窗开颅术和钻孔引流术治疗脑出血疗效的对比研究
[J].中国脑血管病杂志,2004,1(7):2922294.
[35]骆锦标1,孙树杰2,彭彪1,曹志凯1,全伟1,肖国才1,吕建平1,罗东东1,崔明2,方体定向置软管血肿排空术与开颅术救治重型高血压性脑出血的比较分析,大连医科大学学报,第31卷第4期2009年8月Vol.31No.4Aug.2009
[36]衡先培.中西医结合防治糖尿病动脉硬化的思路与方法[J].中国中西医结合杂志,2007,27(8):679.
[37]韦广莹,李晶.醒脑静治疗脑出血60例临床观察[J].山西临床医药实践旬刊,2009,35(12)
[38] Sun SJ, Zou RL, Liu X, et a.l Aspirating serious hyperten-sive intracerebral hematomabyminimally invasive tube in-sertion [J]. Chin J EmergMed,2002,11(5):295-297.
[39]孙树杰,刘欣,聂志余,等.微创置管吸引术治疗高血压性脑出血[J].急诊医学,2002,4:84-87.
[40] PiotrowskiWP,RochowanskiE. Operative results in hyper-tensive intracerebralhaematomas in patients over60[J].Gerontoogy,1996,42:339-347.
[41]骆锦标,孙树杰,彭彪,等,方体定向置软管血肿排空术与开颅术救治重型高血压性脑出血的比较分析[J].大连医科大学学报,2009,(4)
[42] PiotrowskiWP,RochowanskiE. Operative results in hyper-tensive intracerebralhaematomas in patients over60[J].Gerontoogy,1996,42:339-347.
[43] TzaanWC, Lee ST, Lui TN. Combined use of stereotacticaspiration and intracerebralstreptokinase infusion in thesurgical treatment of hypertensive intracerebral hemorrhage[J]. J FormosMed Assoc,1997,96:962-967.
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