目的 探討銀杏內(nèi)酯注射液聯(lián)合注射用尿激酶治療高血壓腦出血的臨床療效。方法 選取2020年4月-2023年5月在新鄉(xiāng)醫(yī)學(xué)院第三附屬醫(yī)院就診的90例高血壓腦出血患者，根據(jù)計(jì)算機(jī)隨機(jī)排列法將所有患者分為對(duì)照組和治療組，每組各45例。對(duì)照組用血腫穿刺針抽吸出血量的1/3左右，使用生理鹽水進(jìn)行反復(fù)沖洗，向血腫腔內(nèi)注入注射用尿激酶，血腫不足50 mL的注入2~3萬(wàn)UI，血腫量≥ 50 mL的患者注入4~6萬(wàn)UI，保留2 h后放開(kāi)引流，每日操作2~3次，血腫清除率≥ 90%后拔除引流管。治療組在對(duì)照組治療的基礎(chǔ)上靜脈滴注銀杏內(nèi)酯注射液，5支/次，1次/d。兩組患者治療2周。觀察兩組的臨床療效，比較兩組的NIHSS評(píng)分、腦血腫體積、平均血流量、臨界壓力、外周阻力指數(shù)和血清網(wǎng)膜素-1（omentin-1）、生長(zhǎng)抑制因子A （Nogo-A）、神經(jīng)特異性烯醇化酶（NSE）水平。結(jié)果 治療后，治療組患者的總有效率為95.56%，明顯高于對(duì)照組的總有效率80.00%，組間比較差異顯著（P<0.05）。治療后，兩組的NIHSS評(píng)分比治療前低、腦水腫體積均顯著縮?。?i>P<0.05），且治療組的NIHSS比對(duì)照組低、腦水腫體積較對(duì)照組縮小更明顯，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組平均血流量高于治療前，臨界壓力、外周阻力指數(shù)低于治療前（P<0.05）；治療組的平均血流量高于對(duì)照組，臨界壓力、外周阻力指數(shù)低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，兩組的血清omentin-1水平明顯升高，血清Nogo-A、NSE水平明顯降低（P<0.05）；治療組的血清omentin-1水平比對(duì)照組高，血清Nogo-A、NSE水平比對(duì)照組低（P<0.05）。結(jié)論 銀杏內(nèi)酯注射液聯(lián)合注射用尿激酶可提高高血壓腦出血的療效，有助于縮小腦水腫體積，促進(jìn)神經(jīng)組織修復(fù)，改善神經(jīng)功能和血流動(dòng)力學(xué)水平。

Objective To investigate the clinical effect of Ginkgolide Injection combined with Urokinase for injection in treatment of hypertensive cerebral hemorrhage. Methods Patients (90 cases) with hypertensive cerebral hemorrhage in the Third Affiliated Hospital of Xinxiang Medical College from April 2020 to May 2023 were divided into control and treatment groups according to the computer random arrangement method, and each group had 45 cases. Patients in the control group used the hematoma puncture needle to draw about 1/3 of the blood volume, repeatedly washed with normal saline, injected Urokinase for injection into the hematoma cavity, injected 20 000 to 30 000 UI if the hematoma volume was less than 50 mL, injected 40 000 to 60 000 UI with the hematoma volume ≥ 50 mL, retained for 2 h, released the drainage, operated 2-3 times daily, and pulled out the drainage tube after the hematoma clearance rate was ≥ 90%. Patients in the treatment group were iv administered with Ginkgolide Injection on the basis of the control group, 5 pieces/time, once daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacies were evaluated, and NIHSS scores, cerebral edema volume, mean blood flow, critical pressure, and peripheral resistance index, and the serum levels of omentin-1, Nogo-A, and NSE in two groups were compared. Results After treatment, the total effective rate of patients in the treatment group was 95.56%, significantly higher than 80.00% in the control group, with significant differences between two groups (P < 0.05). After treatment, NIHSS scores of the two groups were lower than before treatment, and the volume of brain edema in two groups were significantly decreased (P < 0.05). After treatment, NIHSS scores of the treatment group were lower than those of the control group, with a statistically significant difference, and the reduction of the volume of brain edema was more significant in the treatment group compared to the control group (P < 0.05). After treatment, the average blood flow of the two groups was higher than that before treatment, while the critical pressure and peripheral resistance index were lower than before treatment (P < 0.05). The average blood flow of the treatment group was higher than that of the control group, while the critical pressure and peripheral resistance index of the treatment group were lower than those of the control group, with statistically significant differences (P < 0.05). After treatment, the serum levels of omentin-1 in two groups were significantly increased, while the serum levels of Nogo-A and NSE in two groups were significantly reduced (P < 0.05). The serum levels of omentin-1 in the treatment group was higher than that in the control group, while the serum levels of Nogo-A and NSE in the treatment group were lower than those in the control group (P < 0.05). Conclusion Ginkgolide Injection combined with Urokinase for injection can improve the efficacy of hypertensive cerebral hemorrhage, help to reduce the volume of cerebral edema, promote nerve tissue repair, improve nerve function and improve hemodynamics level.

R971

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建項(xiàng)目（LHGJ20210546）