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目的:探讨微创颅内血肿清除术对高血压脑出血患者的治疗作用,及动态TCD监测对患者神经功能恢复的预测价值。方法:选取我院收治的高血压脑出血患者70例,依据治疗方案不同分为微创组及保守组各35例;两组入院后均接受药物保守治疗,微创组同时行尿激酶联合YL-1型血肿穿刺针微创治疗,于治疗前及治疗后第1d、5d、10d和21d行TCD检测,计算血肿及水肿体积变化,并于各时间段行神经功能障碍评分(NIHSS)以评价神经功能恢复情况。结果:微创组治疗后各时间点TCD检测参数Vs、Vd、Vm逐渐升高,PI逐渐降低;保守组治疗后Vs、Vd、Vm先降低后升高,PI先升高后减低,且在治疗后第10d达到低点/峰值;治疗后5d、10d、21d微创组Vs、Vd、Vm高于保守组,PI低于保守组(P<0.05)。治疗后两组脑血肿及水肿体积逐渐降低(P<0.05),微创组各时间点脑血肿及水肿体积明显低于保守组(P<0.05)。治疗后微创组NIHSS评分逐渐下降,保守组NIHSS评分先升高后降低,于治疗后第10d达到峰值,且各时间点均高于微创治疗(P<0.05)。结论:早期微创手术可明显改善高血压脑出血患者血肿周围血流量,利于神经功能恢复,TCD不仅可以用于高血压脑出血患者脑血流量的动态变化监测,对患者神经功能预后具有一定评价价值。
Objective: To investigate the therapeutic effect of minimally invasive intracranial hematoma on patients with hypertensive intracerebral hemorrhage and the predictive value of dynamic TCD in the recovery of neurological function. Methods: Seventy patients with hypertensive intracerebral hemorrhage admitted in our hospital were divided into minimally invasive group and conservative group according to different treatment regimens, 35 cases each received conservative treatment. The minimally invasive group was treated with urokinase combined with YL -1 type hematoma needle minimally invasive treatment before treatment and after treatment 1d, 5d, 10d and 21d TCD detection of hematoma and edema volume changes, and at each time line neurological deficit score (NIHSS) to evaluate Nerve function recovery. Results: The Vs, Vd and Vm of TCD in the minimally invasive group increased gradually and PI gradually decreased at each time point after treatment. Vs, Vd and Vm decreased first and then increased in the conservative group, PI increased first and then decreased, Vs, Vd and Vm in the minimally invasive group were significantly higher than those in the conservative group at 5d, 10d and 21d after treatment, PI were lower than those in the conservative group (P <0.05). After treatment, the volume of cerebral hematoma and edema decreased gradually in both groups (P <0.05). The volume of cerebral hematoma and edema in the minimally invasive group at each time point was significantly lower than that in the conservative group (P <0.05). The NIHSS score of the minimally invasive group decreased gradually after treatment. The NIHSS score of the conservative group first increased and then decreased, reaching the peak on the 10th day after the treatment, and the NIHSS scores in the conservative group were all higher than those in the minimally invasive treatment group (P <0.05). Conclusion: Early minimally invasive surgery can significantly improve blood flow around the hematoma in patients with hypertensive intracerebral hemorrhage and promote neurological recovery. TCD can not only monitor the dynamic changes of cerebral blood flow in patients with hypertensive intracerebral hemorrhage, but also evaluate the prognosis of patients with hypertensive intracerebral hemorrhage value.