穿刺引流术治疗脑室出血115例报告

Minimally Invasive Puncture and Drainage for Ventricular Hemorrhage: Report of 115 Cases

目的探讨微创穿刺引流术治疗脑室出血的疗效。方法 2005年11月-2010年11月对115例CT确诊脑室出血,其中重型脑室出血25例,根据患者脑室出血部位和体积选择性穿刺侧脑室额角,采用双侧或单侧脑室引流,术后尿激酶灌注冲洗,直至脑脊液正常,头颅CT确认血肿消失。结果住院期间治愈或好转88例（76.5%）,植物状态11例,死亡16例。98例随访3-12个月,平均6个月：78例复查头颅CT示脑室大小正常,再出血8例,继发性脑积水5例,死亡7例。结论脑室穿刺引流联合尿激酶灌注冲洗,能尽快清除脑室系统及蛛网膜下腔积血,对降低病死率,提高患者术后生存质量有重要意义。

Objective To evaluate the value of minimally invasive puncture and drainage in the treatment of ventricular hemorrhage.Methods Totally 115 cases of ventricular hemorrhage diagnosed with CT,including 25 cases with severe symptoms,received bilateral or unilateral ventricular and lumbar puncture and drainage in our hospital since November 2005 to November 2010.The frontal horn of the lateral ventricle was punctured selectively according to the position and volume of the hemorrhage.Infusion of urokinase and cerebrospinal fluid exchange were continued till the lesion disappeared in CT image.Results In the 115 cases,88 patients（76.5%） were healed or improved,11 cases were in vegetative status,and 16 cases died.Follow-up was achieved in 98 patients for 3 to 12 months（mean,6 months）,during which CT examination showed the ventricle with normal size in 78 patients,recurrent hemorrhage in 8,secondary hydrocephalus in 5,and death in 7.Conclusions Minimally invasive puncture and drainage combined with urokinase infusion can remove the blood quickly for patients with ventricular hemorrhage.It is very helpful for decreasing mortality and improving life quality.