双侧脑室外引流联合腰大池穿刺持续引流脑脊液治疗全脑室出血铸形的疗效观察

Observation of therapecutic effect of the continuous external drainage of cerebrospinal fluid of bilateral ventricle combined with lumbar cisterna puncture on the treatment of total ventricuiar hemorrrhage

目的 比较联合双侧脑室外引流和腰大池穿刺持续引流脑脊液方法与单纯采用双侧脑室外引流方法治疗全脑室出血铸形的疗效，探讨全脑室出血铸形的有效治疗方法。方法 将经头颅CT确诊的66例患者随机分为两组，A组34例采用双侧脑室外引流联合腰大池穿刺持续引流脑脊液方法治疗，B组32例单纯采用双侧脑室外引流方法治疗，均分别于术后4d、7d、10d、14d和21d，以及术后1个月、3个月和6个月复查头颅CT，了解近期脑室系统内的积血和梗阻性脑积水情况。结果 A、B两组患者的脑室积血分别于术后4～10d、10～21d完全引流，平均分别为6．3d、13．6d；A组无交通性脑积水的发生，B组5例；A组中完全恢复日常生活和部分恢复日常工作或生活自理者占73．53％。B组占37．5％，A组死亡率为11．76％，B组为34．38％，两组比较差异有统计学意义（P〈0．05或P〈0．01）。结论 采用双侧脑室外引流联合腰大池穿刺持续引流脑脊液治疗全脑室出血铸形较单纯采用双侧脑室外引流方法治疗能明显缩短血肿引流清除的时间．后期交通性脑积水的发生得以有效防止，死亡率明显降低，生活能力得到更大改善。

Objective To investigate the effective methods of treament of total ventricular hemorrhage by comparing the result of two kinds of methods of therapy： combining the continuous external drainage of cerebrospinal fluid of bilateral ventricle with lumbar cisterna puncture and only the former. Methods Sixty-six patients diagnosed by CT scanning were randomly divided into two groups： （1）Group A（34 cases） were treated with the continuous external drainage of cerebrospinal fluid of bilateral ventricle combined with lumbar cisterna puncture; （2）Group B （32 cases） were treated with only the continous external drainage of cerebrospinal fluid of bilateral ventricle. The amount of total ventricnlar hemorrhage and obstructive hydrocephalus on the 4th,7th, 10th, 14th, and 21st day after treatment and the occurring rate of communicative hydrocephalus in the first month, 3th month, 6th month after treatment were observed, and the therapecutic effect after 6 month treatment was accessed. Resulta The duration of total drainage of ventricular hemorrhage was as following： group A 4 -10d （average 6.3d）, group B 10 - 21d （average 13.6d） ; the whole recovery and partial recovery： groupA 73.53%, group B 37.5% ;the death rate：group A 11.76%, group B 34.38% ; the occurring rate of communicative hydrocephalus：group A zero （0%） ,group B 5 cases. Conclusion The continuous external drainage of cerebrospinal fluid of bilateral ventricle combined with lumbar cistema puncture could shorten the duration of ventricular hemorrhage more than the therapy of the continuous external drainage of cerebrospinal fluid of bilateral ventricle,effectively prevent the occurring of communicative hydrocepha-lus, decrease the death rate, and improve the ability of dally lives.