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目的探讨低能量氦氖激光血管内照射(ILIB)早期治疗高血压性脑出血(HICH)的疗效、安全性及适宜治疗时机。方法124例急性轻中型HICH患者按病情、出血部位分层,并随机分为四组,基础治疗相同,Ⅰ、Ⅱ、Ⅲ组分别于起病后24h、1周、2周加用ILIB,并分别监测神经功能评分、血肿体积、血液流变学、心电图及并发症。结果(1)ILIB三组总有效率优于Ⅳ组(P<005或<001),Ⅰ组治愈显效率优于其他三组(P<005或<001);(2)治疗4周时四组治疗前后血肿差值(ml)分别为(242±66)、(185±57)、(162±46)、(123±28),两两比较除Ⅱ、Ⅲ组间差异无显著意义(P>005)外,其余各组间差异均有显著意义(P<005或<001);(3)ILIB三组均可降低血粘度、改善心电图异常,Ⅰ组尚可降低肺部感染率,四组间血肿扩大、恶化死亡率差异无显著意义(P>005)。结论早期ILIB辅助治疗轻中型HICH且无凝血障碍者安全有效,可促进血肿吸收,治疗时机以起病后24h为佳。
Objective To investigate the efficacy, safety and appropriate timing of early treatment of hypertensive intracerebral hemorrhage (HICH) by low energy He-Ne laser intravascular irradiation (ILIB). Methods One hundred and twenty-four acute HICH patients were divided into four groups according to their disease and hemorrhage. The basic treatment was the same. ILIB was added to group Ⅰ, Ⅱ and Ⅲ at 24h, 1 week and 2 weeks after onset respectively Neurological function scores, hematoma volume, hemorheology, electrocardiogram and complications were monitored. Results (1) The total effective rate of ILIB group was better than that of Ⅳ group (P <005 or <001), the curative effect of group Ⅰ was better than the other three groups (P <005 or <001); (2) The differences of hematoma before and after treatment were (242 ± 66), (185 ± 57), (162 ± 46) and (123 ± 28), respectively. There was no significant difference between groups Ⅱ and Ⅲ (P <005 or <001). (3) All the three groups of ILIB could reduce the blood viscosity and improve the abnormality of electrocardiogram. In group Ⅰ, the rate of lung infection was still lower, There was no significant difference between the two groups in the hematoma expansion and worsening mortality (P> 005). Conclusion Early ILIB adjuvant treatment of mild to moderate HICH without coagulation disorders are safe and effective, can promote the absorption of hematoma, the timing of treatment to onset of 24h is better.