应用细孔钻颅器脑室外引流治疗丘脑出血破入脑室401例

Rapid pore cranial drilling and ventricular drainage in the treatment of ventricular hemorrhage caused by thalamic hemorrhage： an analysis of 401 cases

目的总结丘脑出血破入脑室系统行细孔钻颅脑室外引流治疗的经验。方法回顾分析1983年5月至2010年12月期间，对山东大学第二医院等5家医院401例丘脑出血破入脑室系统的患者行脑室外引流（部分加尿激酶灌注）的治疗方法，并进行了疗效分析。401例患者中男212例，女189例；年龄19—78岁，平均65．2岁。结果治疗1个月后治愈147例（36．7％），好转192例（47．9％），死亡和自动出院62例（15．4％）。治疗1～3个月出院按日常生活能力（ADL）评定预后：Ⅰ级147例，Ⅱ级82例，Ⅲ级76例，Ⅳ级19例，V级15例，死亡43例，自动出院19例。对274例随访了1～3年，Ⅰ级122例，Ⅱ级63例，Ⅲ级58例，31例死于肺部感染。结论对丘脑出血破入脑室系统的患者行细孔钻颅脑室外引流（部分加尿激酶灌注）是理想的治疗方法。

Objective To summarize the clinical efficacies and experiences of using rapid pore cranial drilling and external ventricular drainage （EVD） in the treatment of ventricular hemorrhage caused by thalamic hemorrhage. Methods Retrospective analysis was conducted for 401 patients at 5 hospitals from May 1983 to December 2010. They underwent EVD with an infusion of urokinase for intraventricular hemorrhage caused by thalamic hemorrhage. There were 212 males and 189 females with an age range of 19 -78 years. Results After a 1-month therapy, the outcomes were cure 147/401 （36. 7% ）, improvement 192/401 （47. 9% ） and others （ death and against-advice discharge） 62/401 （ 15. 4% ）. After 1 - 3-month treatment, their prognoses were evaluated by activity of daily living （ADL） ：ADL Ⅰ 147/401, ADL Ⅱ 82/ 401, ADLⅢ 76/401, ADLⅣ19/401, ADLⅤ15/401, death 43/401 and against-advice discharge 19/ 401. During a follow-up period of 1 -3 years, 274 patients showed the following outcomes ：ADL Ⅰ 122/243, ADL Ⅱ 63/243, ADL Ⅲ 58/243 while 31 patients died from pulmonary infection. Conclusion The procedure of EVD （ including an infusion of urokinase） with rapid pore cranial drilling is preferred treatment for ventricular hemorrhage caused by thalamic hemorrhage.