目的 探讨银杏内酯注射液联合注射用尿激酶治疗高血压脑出血的临床疗效。方法 选取2020年4月-2023年5月在新乡医学院第三附属医院就诊的90例高血压脑出血患者，根据计算机随机排列法将所有患者分为对照组和治疗组，每组各45例。对照组用血肿穿刺针抽吸出血量的1/3左右，使用生理盐水进行反复冲洗，向血肿腔内注入注射用尿激酶，血肿不足50 mL的注入2~3万UI，血肿量≥ 50 mL的患者注入4~6万UI，保留2 h后放开引流，每日操作2~3次，血肿清除率≥ 90%后拔除引流管。治疗组在对照组治疗的基础上静脉滴注银杏内酯注射液，5支/次，1次/d。两组患者治疗2周。观察两组的临床疗效，比较两组的NIHSS评分、脑血肿体积、平均血流量、临界压力、外周阻力指数和血清网膜素-1（omentin-1）、生长抑制因子A （Nogo-A）、神经特异性烯醇化酶（NSE）水平。结果 治疗后，治疗组患者的总有效率为95.56%，明显高于对照组的总有效率80.00%，组间比较差异显著（P<0.05）。治疗后，两组的NIHSS评分比治疗前低、脑水肿体积均显著缩小（P<0.05），且治疗组的NIHSS比对照组低、脑水肿体积较对照组缩小更明显，差异有统计学意义（P<0.05）。治疗后，两组平均血流量高于治疗前，临界压力、外周阻力指数低于治疗前（P<0.05）；治疗组的平均血流量高于对照组，临界压力、外周阻力指数低于对照组，差异有统计学意义（P<0.05）。治疗后，两组的血清omentin-1水平明显升高，血清Nogo-A、NSE水平明显降低（P<0.05）；治疗组的血清omentin-1水平比对照组高，血清Nogo-A、NSE水平比对照组低（P<0.05）。结论 银杏内酯注射液联合注射用尿激酶可提高高血压脑出血的疗效，有助于缩小脑水肿体积，促进神经组织修复，改善神经功能和血流动力学水平。
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.