本文選題：尿激酶 + 腦出血��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:觀察不同劑量(大劑量5萬u/次,中劑量3萬u/次,小劑量1萬u/次)尿激酶對腦出血微創(chuàng)置管術后患者腦內血腫溶解引流的效果、臨床療效、安全性的影響,進行統(tǒng)計學分析,進行對比研究,探討合適劑量,以保證療效,避免浪費,減少可能的副作用,并對臨床現(xiàn)象作出相應機制推測。方法:選擇行腦內血腫微創(chuàng)置管術的腦出血病人66例,所有患者符合《中華人民共和國衛(wèi)生行業(yè)標準:成人自發(fā)性腦出血診斷標準(WS320-2010)》,并制定排除標準,以剔除可能對結果有干擾的病例。所有入選患者腦內血腫量在35~50ml之間,自發(fā)病開始至應用尿激酶時間在10-14小時之間。根據尿激酶給予劑量,將患者隨機分為三組,A組(22人)給予尿激酶1萬u+生理鹽水5ml溶解后腦內引流管注入;B組(22人)給予尿激酶3萬u+生理鹽水5ml溶解后腦內引流管注入;C組(22人)給予尿激酶5萬u+生理鹽水5ml溶解后腦內引流管注入。以上三組患者均在尿激酶注入后夾閉引流管,2小時后放開,每8小時注入一次尿激酶,共注入6次。注意防治并發(fā)癥。所有患者術后立即復查CT檢查,注射6次尿激酶后再次復查CT,多田公式計算血腫體積,然后計算出血腫清除率,血腫清除率=(術后注射尿激酶前血腫體積-注射尿激酶6次后血腫體積)/術后注射尿激酶前血腫體積,術后常規(guī)止血、應用抗生素、脫水、保護腦細胞、預防應激性潰瘍、支持營養(yǎng)等治療,對比分析三組患者注射6次尿激酶后腦內血腫清除率、術后第14天致殘MRS評分、術后14天GCS評分等指標。結果:在腦出血患者行腦內血腫置管引流術治療中,從臨床療效看,尿激酶1萬u組(A組)、3萬u組(B組)、5萬u組(C組)任意兩組腦內血腫清除率、術后第14天致殘MRS評分等、術后14天GCS評分比較差異無統(tǒng)計學差異(P0.05),從術后并發(fā)癥看,3組患者術后肺部感染、上消化道出血數(shù)據比較差異無統(tǒng)計學意義(P0.05),但A、B組癲癇發(fā)生率分別與C組相比較差異有統(tǒng)計學意義(P0.05),A、B組之間比較差異無統(tǒng)計學意義(P0.05),A、B組癲癇發(fā)病率要明顯小于C組。結論:在腦出血患者行腦內血腫置管引流術治療中,應用尿激酶可以促進血腫溶解排出,減少血腫毒性和占位效應。應用尿激酶1萬u、3萬u、5萬u這三種不同劑量組取得的臨床效果相似,從腦內血腫清除率、術后第14天致殘MRS評分等、術后14天GCS評分這幾個指標看,數(shù)據對比差異不明顯,無統(tǒng)計學意義。癲癇術后發(fā)生率5萬u組明顯較其余兩組高。在本研究中,不同劑量尿激酶在本試驗中對腦內血腫引流效果無明顯差異,小劑量尿激酶療效未見降低,而副作用少,值得臨床中推廣應用。
[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.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.1

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