双侧脑室引流联合脑脊液置换治疗重型脑室出血的临床研究

Clinical study on the treatment of severe intraventricular hemorrhage by bilateral ventricular drainage and cerebrospinal fluid exchange

目的探讨治疗重型脑室出血的有效治疗方法。方法将52例重型脑室出血患者作为治疗组,行双侧脑室外引流术联合脑脊液置换,每天2次向脑室内注入尿激酶2～4万U,夹管2h后开放引流血性脑脊液。术后每2～3d复查头部CT,脑室内积血基本清除后拔管。将以往单侧脑室引流的45例作为对照组。结果术后72h,治疗组意识转清率升高;术后第7天,治疗组血肿清除率提高,血肿引流时间缩短。4周后根据GOS评分,治疗组优良16例,轻残26例,重残6例,死亡4例;对照组优良7例,轻残18例,重残11例,死亡9例,以优良和轻残视为有效,治疗组有效率80.8%,对照组有效率55.6%,两组比较差异有统计学意义。结论该方法是一种治疗脑室出血的有效方法,可提高脑室出血患者的生存质量和生存率。

Objective To seek the effective way for the therapy of severe intraventricular hemor- rhage （ SIVH ）. Methods 52 patients with SIVH was treatment group,who were treated after External bilateral ventricular drainage with direct intraventricular infusion of 20 000 -40 000 U urokinase dissolved in with 4 mL sterile physiological saline, the drainage tube was closed for 2 h each time, and cerebrospinal fluid exchang through lumbar puncture was done on the next day. The drainage tube was withdrawn when the ventricle was cleaned under the CT scan. The control group was treated by unilateral ventricular drainage and intraventricular infusion of urokinase. Results In the treatment group, 72 h after the operation, the recovery rate of patients＂ consciousness increased, the clearance rate of hematoma increased 7d after the operation, and the duration of hematoma drainage in the treatment group shortened. The GOS at discharge in the treatment group： 16 cases were in good recovery, 26 in mild disability, 6 in severe disability and 4 died. In the control group, 7 cases were in good recovery, 18 in mild disability, 11 in severe disability and 9 died. Good recovery and mild disability were regarded as be effective. The effective rate was 80.8% in treatment group and 55.6% in the control group, there were obvious differences in effective rate between the two groups. Conclusion Intraventricular infusion of urokinase with external ventricular drainage is effective in the treatment of SIVH, and can improve the survival rate and life quality of SIVH.