钻颅行脑室外引流和腰椎置管脑脊液引流治疗破入脑室的高血压脑出血

Treatment of hypertensive cerebral hemorrhage broken into ventricular by ventricular puncture combinding continuous external lumbar drainage

目的探讨应用钻颅行脑室外引流和腰椎置管脑脊液引流治疗破入脑室高血压脑出血的安全性和有效性,提高抢救成功率,降低死亡率。方法 56例高血压、脑出血患者在局麻下采用自制的颅锥于床边行单侧脑室或双侧脑室前角锥孔后穿刺置管引流术,在术后5～6h将尿激酶1～2万单位加入生理盐水中稀释至4～5ml注入脑室并夹闭引流管,头部抬高30°,2～4h后开放引流管,每日2次。双侧引流则采用交替开放与夹闭引流。侧脑室引流3～7d后,腰椎置管引流脑脊液。结果患者恢复良好19例,中残14例,重残9例,死亡14例,死亡率25%。结论采用床边锥颅脑室引流和腰椎置管脑脊液引流抢救治疗破入脑室内高血压脑出血的方法,具有微创、快捷、方便、安全、有效等特点,可在基层医院开展。

Objective To evaluate the safety and effectiveness of treatment of hypertensive cerebral hemorrhage broken into ventricular by ventricular puncture combinding continuous external lumbar drainage and improve the success and reduce mortality.Methods 56 patients received single or double ventricular puncture and drainage at the anterior horn using self-made cones at the bedside under local anesthesia.5-6 hours after the puncture,10,000-20,000 units of urokinase diluted to 4-5ml was injected into ventricles,the drainage tubes were occluded,head was elevated 30°,2-4hous later,drainage pipe was opened,repeat the operation twice per day.Bilateral drainage is applied alternately open and clamping drainage.Lumbar drainage of cerebrospinal fluid was taken 3-7 days after ventricular puncture and drainage.Results19 cases had favourable outcome,14 cases were middle disabled,9 cases were the severely disabled,14 patients were dead,the mortality rate was 25%.Conclusion Treatment of hypertensive cerebral hemorrhage broken into ventricular by ventricular puncture combinding continuous external lumbar drainage was micro-invasive,fast,convenient,safe and effective,it can be carried out in primary hospitals.