自发性脑室内出血治疗方案的选择

The Choice of Spontaneous Intraventricular Hemorrhage Treatment Project

目的:探讨自发性脑室内出血的最佳治疗方案。方法:对112例自发性脑室内出血患者分别采用内科治疗、脑室引流术和血肿清除术治疗,比较观察患者的治疗效果。结果:自发性脑室内出血Ⅰ级患者内科治疗方式最佳,死亡率为0,而侧脑室穿刺外引流术死亡率为25.0%,血肿清除术死亡率为20%。Ⅱ级患者以侧脑室穿刺外引流术治疗效果最佳,死亡率仅为22.2%。Ⅲ级患者以血肿清除术治疗效果最佳,死亡率为62.5%。Ⅳ级患者死亡率均为100%。自发性脑室内出血Ⅰ级患者超早期、早期和延期手术死亡率比较,差异无统计学意义(P>0.05)。Ⅱ级、Ⅲ级患者以超早期治疗效果最佳,死亡率分别为9.1%和53.3%。结论:自发性脑室内出血I级患者宜采用内科治疗,Ⅱ级患者宜行超早期侧脑室穿刺外引流术,Ⅲ级患者以超早期血肿清除术治疗效果最佳,Ⅳ患者尚缺乏有效治疗手段,还需临床进行积极探索。

Objective：To discuss the best project of spontaneous intraventricular hemorrhage treatment. Methods： 112 cases with spontaneous intraventricular hemorrhage were treated with medical therapy, shunt surgery and hematoma evacuation, and the effect were compared. Results ： In spontaneous intraventricular hemorrhage, grade I patients were treated with medical treatment with the best, and the mortality rate was 0%, while the mortality rate of shunt surgery were 25.0%, mortality rate of hematoma evacuation were 20%. Grade II patients were treated with shunt surgery with the best, the mortality rate was only 22.2%. Patients with grade III were treated with hematoma evacuation with the best, the mortality rate was only 62.5%. The mortality rate of grade IV patients were 100%. Spontaneous intraventricular hemorrhage grade I patients with ultra-early, early and delayed surgical mortality, the difference was not statistically significant （P〉0.05）. Patients with grade II and III with ultra-early treatment, the mortality rate was 9.1% and 53.3% . The mortality rate of grade IV patients were 100%. Conclusion： Spontaneous intraventricular hemorrhage grade I patients should adopt medical treatment, grade II patients should adopt ultra-early shunt surgery, grade III patients should adopt ultra-early hematoma evacuation, and grade IV patients with no effective treatment, needed clinical actively explore.