关键词: 微孔穿刺引流术, 尿激酶, 脑出血, 脑水肿

Abstract: Objective  To observe the effects of minimally invasive puncture and drainage combined with urokinase on the severity of cerebral edema,serum malondialdehyde(MDA),matrix metalloproteinase-9(MMP-9) and intercellular adhesion molecule-1(ICAM-1) after cerebral hemorrhage.Methods A total of 82 patients with hypertensive intracerebral hemorrhage(HICH) admitted to our hospital were retrospectively enrolled between January 2020 and September 2022.According to different treatment methods,they were divided into two groups: observation group (44 cases, control group combined with UK) and control group (38 cases,control treatment).The cerebral edema volume,nerve function [National Institutes of Health Stroke Scale(NIHSS)] and serological indexes(MDA,MMP-9,ICAM-1) in both groups were observed.The occurrence of postoperative complications was recorded.The prognosis [scores of Glasgow Outcome Scale(GOS) and activity of daily living scale(ADL),death] in the two groups was compared at 3 months after surgery.Results  At 14d after surgery,peripheral cerebral edema volume in the observation group was smaller than that in the control group[(14.76±2.39) ml vs(16.87±2.24) ml,P<0.05],NIHSS score was lower than that in the control group[(11.12±1.96) points vs(11.96±1.65) points,P<0.05].The levels of serum MDA,MMP-9 and ICAM-1  in the observation group were (8.65±1.16)nmol/ml,(96.17±19.34)ng/ml and (624.31±32.76)μg/ml,respectively,which were lower than those in the control group[(16.14±2.16) nmol/ml,(120.47±21.32) ng/ml,(661.24±35.21)μg/ml,P<0.05].There was no significant difference in incidence of postoperative complications between the observation group and the control group(9.09% vs 18.42%,P>0.05).There was no death in either group within 3 months after surgery.At 3 months after surgery,GOS and ADL scores in the observation group were (4.03±0.92) points and (71.21±12.65) points,which were higher than those in the control  group[(3.52±1.12) points,(62.98±15.58) points,P<0.05].Conclusion  The control combined with UK can effectively control cerebral edema,down-regulate MDA,MMP-9 and ICAM-1 levels,protect nerve function and improve prognosis in HICH patients.

Key words: minimally invasive puncture and drainage, urokinase, cerebral hemorrhage, cerebral edema