脑室外引流联合早期腰大池引流治疗重型脑室出血的临床分析

Clinical analysis of external ventricular drainage combined with early lumbar cistern drainage in the treatment of severe intraventricular hemorrhage

目的探讨脑室外引流联合早期腰大池引流在重型脑室出血患者治疗中的应用价值。方法52例重型脑室出血患者随机分成治疗组和对照组,治疗组采用双侧脑室外引流联合腰大池引流+尿激酶治疗,而对照组采用双侧脑室外引流+尿激酶治疗,观察比较两组患者三、四脑室积血完全消散时间、双侧脑室外引流管拔除时间及颅内感染、脑积水发生率;进一步评估两组患者术后6个月预后的差异。结果治疗组患者脑室积血完全消散时间及双侧脑室引流管拔除时间均较对照组缩短(P<0.01);治疗组术后3个月脑积水发生率明显低于对照组(P<0.05),而颅内感染率较对照组差异无统计学意义(P>0.05);术后6个月治疗组有效率为61.54%,高于对照组的30.77%。结论脑室外引流联合早期腰大池引流能够加快三、四脑室积血清除,减少延期性脑积水发生,改善重型脑室出血患者预后。

Objective To explore the application value of external ventricular drainage(EVD)combined with early lumbar drainage(LD)in the treatment of severe intraventricular hemorrhage(IVH).Methods Fifty-two patients with severe intraventricular hemorrhage(IVH)were randomly divided into the treatment group and control group.The treatment group was treated with bilateral external ventricular drainage combined with lumbar drainage(LD),while the control group was treatde with bilateral external ventricular drainage.Urokinase was used in both groups.The time of complete clearance of hematoma in the third and fourth ventricles,the time of removal of bilateral ventricular drainage tube,the incidence of intracranial infection and delayed hydrocephalus were observed and compared between the two groups.The prognosis after 6 months of operation in two groups were also evaluated.Results The time of complete clearance of hematoma and the time of removal of drainage tube in the treatment group were both less than those of control group(P<0.01).The incidence of hydrocephalus in the treatment group three months after operation was significantly lower than that in the control group(P<0.05),while there was no significant difference in intracranial infection rate between the two groups.The effective rate of treatment group was 61.54%six months after operation,which was significantly higher than 30.77%of the control group(P<0.05).Conclusion The combined treatment approach of external ventricular drainage(EVD)and early lumbar drainage(LD)can result in faster hematoma clearance in the third and fourth ventricles,reduce the incidence of delayed hydrocephalus,and help improve the prognosis of severe IVH patients.