尿激酶聯合CT引導穿刺引流術治療基底節區高血壓腦出血患者的療效及安全性分析

【關鍵詞】尿激酶；CT引導；穿刺引流術；基底節區高血壓腦出血；療效；安全性【中圖分類號】 R651.1⁺1 【文獻標志碼】 B 【文章編號】1672-7770（2025）03-0314-06

Abstract：ObjectiveTo explore the therapeutic eficiencyand safety profile of a combination therapy involving urokinase and CT-directed puncturedrainage for managing basal ganglia hypertensive cerebral hemorrhage.Methods A total of96 individualssuffring from hypertensivecerebralhemorrhage inthebasal ganglia，who were treated at CT Room of Zhangjiakou First Hospital from January 2O22 to December 2O23 were enroled.These patients were randomly dividedinto control group and experimental group，with an equal numberof 48 participants ineach. Traditional craniotomywas the treatmentapproach forthecontrol group，whereas the experimental groupreceived CTguided puncture and drainage with adjunctive urokinase. The outcomes of the two groups were compared，including therapeutic outcomes，postoperative recuperation measuredby hematoma resolutionrate，time to spontaneous opening，cerebral edema volume oneweek post-surgery，and Glasgow coma scale（GCS），stress-related tumor indices，including adrenocorticotropic hormone（ACTH）and serum cortisol（Cortisol，ACTH，Cor），and therateof complications，such asrebleeding，gastrointestinal bleeding，intracranial infection，pulmonary infection，seizures， and brain herniation.ResultsTheexperimental group demonstrateda superior total eficacy ratecompared to the control group（ Plt;0.05 ）．Additionally，this group exhibited reduced self-opening times and postoperative cerebral edema volumes at one week，along with increased hematoma resolution rates and GCS scores one week post-surgery， when contrasted with the control group（ Plt;0. 05 ）.Post-treatment，both groups showed elevated levels of stressrelated tumor indices，but the experimental group had lower levels compared to the control group（ Plt;0. 05 ）. Moreover，the experimental group experienced a lower incidence of adverse events than the control group（ Plt;0.05 ）

ConclusionsThe therapeutic approach combining urokinase with CT-guided puncture and drainage for treating basal ganglia hypertensive cerebral hemorrhagepatientsisproved tobeclinicallefective.Itenhances postoperative recovery，mitigatespostoperative stress responses，improves patient prognosis，and exhibitsahigh levelof safety， thus warranting wider adoption and consideration.

Key words：urokinase；CT guidance；puncture drainage；hypertensive cerebral hemorrhage in basal ganglia; urative effect； safety

高血壓腦出血在神經外科是十分常見的急危重癥，隨著人口老齡化發展、不良飲食及生活習慣的增加、生活壓力的加劇，此病癥的發病率常年居高[1]。高血壓所致腦出血，全腦各處皆可出現，最易出現的區域是基底節區，在所有高血壓腦出血患者中，基底節腦出血約占 70%^[1-3] 。既往的傳統開顱顯微鏡下手術是治療基底節區高血壓腦出血的常用手段，而近年來隨著微創理念的發展，以及手術器械的不斷更新，微創手術越來越受到神經外科醫師的重視，計算機斷層掃描（computed tomography，CT）引導穿刺引流術治療基底節區高血壓腦出血已逐步顯現出優越性。有研究表明，對于基底節區高血壓腦出血患者，接受CT引導穿刺引流術治療的患者有較低的并發癥風險和較短的手術時間，治療效果優于傳統開顱手術者[4]。盡管這種技術難以徹底消除所有的血腫，但殘留的血腫依舊可能引發炎癥反應和局部的水腫問題，這可能會對患者恢復情況帶來不利的影響[5]。根據相關研究，術后采用尿激酶進行溶栓治療，可以對體內的纖溶系統產生直接作用，促使血腫液化并順利排出，從而加速吸收過程，縮短治療周期[6-7]。本研究回顧性分析2022年1月—2023年12月張家口市第一醫院收治的96例基底節區高血壓腦出血患者，旨在探討分析尿激酶聯合CT引導穿刺引流術治療基底節區高血壓腦出血患者的療效及安全性。……