脑室出血的三级治疗方案

The three-level strategy of treatment for intraventricular hemorrhage

目的探索脑室出血的分级治疗方案。方法按修改Graeb评分标准观察了237例脑室出血（IVH）患者的积血评分、出血后脑积水（PHH）及病程21d内病死率。用Logistic回归法建立并发PHH的预测方程，以5％与95％二概率点将观察样本分为三个段别，提出初步三级治疗方案。应用X^2检验比较各评分点组治疗方法对病死率的影响，修正上述三级治疗方案。结果按修改Graeb评分标准，评分1—4段中各点PHH发生概率小于5％，内科保守治疗的病死率在各点均为0；PHH发生概率大于95％的评分点于11-12间，外科引流能显著降低10-12段内各评分点组的病死率；而评分5～9者，PHH发生概率为9．6％～81．0％，内科保守或外科引流对该段内各评分点组的病死率影响差异无统计学意义。结论按修改Graeb评分标准，据IVH评分大小分三级治疗：一级即评分1～4者行内科保守治疗；二级即评分5～9者可在有外科引流准备的条件下行内科保守治疗；三级即评分10～12者应予以积极的外科引流。

Objective To explore a practical strategy in treating intraventricular hemorrhage （IVH）. Methods All 237 patients were rolled in this study for investigating IVH grade, post-hemorrhagic hydrocephalus （PHH） and mortality rate in 21 days. The probability of PHH was predicted by Logistic regressions. According to the probability of PHH, three-level strategy was plotted by probability points of 5% and 95%. As comparing with the mortality rate in each grading point group by Chi-square test, a different therapy for each group should be taken, and the strategy could be modified~ Results According to the modified Graeb criteria, conservative treatment should be taken for the first level grading point from 1 to 4, in which the probability of PHH was less than 5% and the mortality rate was 0; and when conservative treatment was performed, a drainage should be considered for the second level grading point from 5 to 9, in which the probability of PHH was from 9. 6% to 81.0%, and the difference of mortality rate was not significant between the two therapeutic methods. A drainage should be performed in the third level grading point from 10 to 12, in which the probability of PHH was more than 90% and the mortality rate was reduced. Conclusions According to the modified Graeb criteria, the treatment for IVH could be graded for three levels. Conservative treatment might be adapted for the first level grading from 1 to 4, and used when preparation for drainage was ready for the second level grading from 5 to 9. Howeuer, a drainage should be performed immediately for the third level grading from 10 to 12.