CAJ | 학술논문

目的：探讨尿激酶在高龄、大量脑出血患者两种微创治疗中的应用效果。方法选择大量脑出血（60~80 ml）的高龄患者（75~89岁）42例，采用单盲法，按入院时间随机分为治疗组22例，对照组20例。治疗组患者行血肿腔额、颞分别钻孔，尿激酶生理盐水溶液持续血肿腔冲洗；对照组患者行血肿腔单纯颞部钻孔1个，间断尿激酶溶液冲洗。观察并记录两组患者的血肿清除时间，术后并发症，出院时及术后6个月日常生活功能评定（ ADL），后者按Barthel指数评定量表评价，最后进行对比分析。结果治疗组血肿平均清除时间为48.42±3.5 h，对照组血肿平均清除时间为75.5±4.6 h；术后再出血：治疗组2例，对照组2例，均行开颅手术治疗；颅内感染发生率均为0；肺炎：治疗组10例，对照组11例；应激性溃疡：治疗组12例，对照组10例；出院时Barthel评分：治疗组：Ⅰ级3例，Ⅱ级5例，Ⅲ级8例，Ⅳ~Ⅴ级3例，放弃治疗3例，经随访患者死亡；对照组：Ⅰ级2例，Ⅱ级2例，级Ⅲ4例，Ⅳ~Ⅴ级8例，死亡2例，放弃治疗2例，经随访患者死亡。6个月左右回访，日常生活功能评定（ ADL），Barthel评分：治疗组：Ⅰ级3例，Ⅱ级4例，Ⅲ级6例，Ⅳ~Ⅴ级5例，死亡1例；对照组Ⅰ级2例，Ⅱ级2例，Ⅲ级3例，Ⅳ~Ⅴ级7例，死亡2例。结论对于高龄、大量脑出血患者，额、颞分别钻孔行尿激酶溶液持续冲洗治疗与单一颞部钻孔尿激酶溶液间断冲洗治疗，二者术后再出血、肺炎、应激性溃疡等并发症无显著差异，而前者血肿清除快，出院时日常生活功能评分明显高于后者，但二者术后6个月时日常生活功能评定无明显差异。
목적：탐토뇨격매재고령、대량뇌출혈환자량충미창치료중적응용효과。방법선택대량뇌출혈（60~80 ml）적고령환자（75~89세）42례，채용단맹법，안입원시간수궤분위치료조22례，대조조20례。치료조환자행혈종강액、섭분별찬공，뇨격매생리염수용액지속혈종강충세；대조조환자행혈종강단순섭부찬공1개，간단뇨격매용액충세。관찰병기록량조환자적혈종청제시간，술후병발증，출원시급술후6개월일상생활공능평정（ ADL），후자안Barthel지수평정량표평개，최후진행대비분석。결과치료조혈종평균청제시간위48.42±3.5 h，대조조혈종평균청제시간위75.5±4.6 h；술후재출혈：치료조2례，대조조2례，균행개로수술치료；로내감염발생솔균위0；폐염：치료조10례，대조조11례；응격성궤양：치료조12례，대조조10례；출원시Barthel평분：치료조：Ⅰ급3례，Ⅱ급5례，Ⅲ급8례，Ⅳ~Ⅴ급3례，방기치료3례，경수방환자사망；대조조：Ⅰ급2례，Ⅱ급2례，급Ⅲ4례，Ⅳ~Ⅴ급8례，사망2례，방기치료2례，경수방환자사망。6개월좌우회방，일상생활공능평정（ ADL），Barthel평분：치료조：Ⅰ급3례，Ⅱ급4례，Ⅲ급6례，Ⅳ~Ⅴ급5례，사망1례；대조조Ⅰ급2례，Ⅱ급2례，Ⅲ급3례，Ⅳ~Ⅴ급7례，사망2례。결론대우고령、대량뇌출혈환자，액、섭분별찬공행뇨격매용액지속충세치료여단일섭부찬공뇨격매용액간단충세치료，이자술후재출혈、폐염、응격성궤양등병발증무현저차이，이전자혈종청제쾌，출원시일상생활공능평분명현고우후자，단이자술후6개월시일상생활공능평정무명현차이。
Objective To probe the effect of urokinase minimally invasive therapy for aged patients with massive cerebral hemorrhage. Methods By single blind method,42 aged patients(75-89 years old)with massive cerebral hemorrhage(60~80 ml)were randomly divided into two treatment groups. Patients in control group(20 cases)were treated by traditional temporal drillings and intermittent urokinase solution irri-gation. Patients in experimental group(22 cases)were treated by continuous urokinase solution irrigation through two drillings on forehead and temple region. The hematoma evacuation time,rebleeding rate,postoperative complications were observed and recorded. Barthel index was used to assess the activities of daily living( ADL)at hospital discharge and 6 months after operations. Results In control group,the average hematoma evacuation time was 75. 5 ± 4. 6 h,however,in experimental group,it was only 48. 4 ± 3. 5 h. Two cases in experimental group,and 2 cases in control group had rebleeding after treatment. The intracranial infection rate was 0% in both groups;10 cases in experimental group,and 11 cases in control group had pneumonia;12 cases in experimental group,10 cases in control group had stress ulcer. For Barthel score at discharge,the ex-perimental group had grade I in 3,grade II in 5,grade III in 8,grade IV~V in 3;and 3 cases gave up treatment. The control group had grade I in 2,grade II in 2,grade III in 4,grade IV~V in 8,and 2 cases died during the treatment,2 cases gave up treatment. For Barthel score at 6 months after treatment,experimental group had grade I in 3,grade II in 4,grade III in 6,grade IV ~ V in 5 and 1 case of death;control group had grade I in 2,grade II in 2,grade III in 3 and grade IV~ V in 7,and 2 cases of death. Conclusion Frontal and temporal drillings with con-tinuous urokinase solution irrigation might be a better treatment than the traditional temporal drillings with intermittent urokinase solution irrigation for aged patients with massive cerebral hemorrhage. Although no significant differences in intracranial infection rate,stress ulcer rate,pneumonia rate,rebleeding rate and ADL scores at 6 postoperative months between two methods,significant shorter hematoma evacuation time and higher ADL scores at hospital disdischarge were observed in patients received the treatment of frontal and temporal drillings with continuous urokinase solution irrigation.