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 Cerebralspinal Fluid Exchange

目的评价双侧脑室外引流联合脑脊液置换治疗重型脑室出血的临床疗效。方法将36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2 h 后开放引流血性脑脊液。术后每2～3 d 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36例作为对照组。结果术后48 h,治疗组神志清楚27例,占61.0%;对照组神志清楚17例,占47.2%,2组比较有显著性差异,P<0.05。术后第7 d,治疗组31例脑室内血肿基本清除,占86.1%;对照组23例脑室内血肿基本清除,占63.9%,2组比较有显著性差异,P<0.05。治疗组引流时间2～7 d,平均4 d;对照组引流时间2～15 d,平均9 d,治疗组引流时间明显缩短。1月后 GCS 评分,治疗组优良11例,轻残18例,重残4例,死亡3例;对照组优良6例,轻残14例,重残9例,死亡7例。以优良和轻残视为有效,治疗组有效率80.6%,对照组有效率55.6%,2组比较有显著性差异。结论双侧脑室引流联合脑脊液置换综合治疗脑室出血是一种安全、有效、可行的治疗措施。

Objective To evaluate the therapeutic efficacy of intraventricular infusion of urokinase accompanied with external bilateral ventricular drainage（EBVD） and cerebral fluid exchange on severe intraventricular hemorrhage （SIVH）. Methods 36 patinents with SIVH was treatment group,this group was treated after EBVD with direct intraventricular infusion of 20 000 -40 000 u urokinase with 4 ml sterile physiological saline twice daily and closing the drainage tube for two hours each time,cerebrospinal fluid exchangt through lumbar puncture on the next day. The drainage tube was withdrawn when CT scan showed the ventricle was cleaned. The control group was treated by unilateral ventricular drainage and intraventricular infusion of urokinase. Results 48 hour after the operation,in the treatment group,27 patients （61%） returned to the consciousness,in the control group 17 patients（47.2% ） returned to the consciousness,there were an obvious difference between them（ P 〈 0. 05 ）. In the treatment group, the hematoma was completely drained in 2 - 7 days （mean 4 days）, 7days after the operation, the hematoma was complelely drained in 31 patients. In the control group, it was 2 - 15 days （ mean 9 days） ,7 days after operation the hematoma was completely drained in 23 patients,so that the duration of hematoma dissolving in the treatment group was shorter than control group. The COS at discharge in the treatment group ：11 cases were in good recovery,17 cases in mild disablement. 5 in severe disablement and 3 died. In the control group,6 casas was in good recovery,14 in mild disablement,9 in severe disablement and 7 died. Good recovery and mild disablement were regarded as effection. In treatment group,the effect rate was 80.6% ,while in the control group,the effective rate was 55.6% ,there were an obvious difference in effective rate between the two groups. Conclusion lntraventricular infusion of urokinase accompanied with EVD is simple,effective,safe and reliable in treating IVH.