侧脑室与腰大池联合置管引流治疗脑室内铸型血肿临床疗效分析

Clinical effect analysis of ventricle and lumbar cistern drainage in the treatment of intraventricular cast hematoma

目的：对比分析侧脑室与腰大池联合置管引流与单纯侧脑室置管引流治疗脑室内铸型血肿的疗效。方法回顾性对比分析本科2008年7月~2013年6月期间收治的75例脑室内铸型血肿患者临床资料,随机分为两组, A组（治疗组）39例,行侧脑室与腰大池联合置管引流术；B组（对照组）36例,单纯行侧脑室置管引流术。两组术后均常规予尿激酶定时脑室灌注,血肿引流超过95%以上拔管,引流管留置7 d以上患者均予抗生素定时脑室冲洗预防感染。使用SPSS11.0软件进行统计学处理。结果 A组患者有效率82.05%,血肿清除时间5~11 d,平均7.2 d；B组患者有效率69.44%,血肿清除时间6~14 d,平均10.8 d。两组比较差异有统计学意义（P〈0.05）。术后颅内感染率、脑积水发生率A组均低于B组,差异有统计学意义（P〈0.05）。结论侧脑室与腰大池联合置管引流治疗脑室内铸型血肿效果优于单纯侧脑室置管引流,并可以减少颅内感染及脑积水并发症的风险。

Objective To compare clinical curative effect of ventricle and lumbar cistern drainage and ventricle cistern drainage lonely on intraventricular cast hematoma. Methods To conduct a retrospective comparative analysis on the clinical materials of 75 patients wih intraventricular cast hematoma treated from Junly 2008 to June 2013. The materials were divided into 2 groups at random. Group A（treatment group, n=39） were treated with ventricle and lumbar cistern drainage. Group B（control group, n=36） were treated with simple lateral ventricle drainage. All cases were routinely performed timing urokinase intraventricular perfusion after the surgery. Tube withdraw was conducted with wih more than 95%hematoma drainage. The cases indwelling drainage tube for more than 7 days were done timing ventricle washing with antibiotics to prevent infection. This paper processes the gained data in a statistical way with the the use of the software SPSS11.0. Results The effective rate of group A reached 82.05%. The hematoma clearance time ranged from 5~11 days, and its average time was 7.2 days. The effective rate of group B reached 69.44%.The hematoma clearance time ranged from 6 days to 14days, and its average time was 10.8 days. There was significant difference between two groups（P〈0.05）.The rate of the occurance of postoperative intracranial infection and hydrocephalus in group A was lower than that in group B, which was also a significant difference（P〈0.05）. Conclusion The effect of ventricle and lumbar cistern drainage is better than ventricle cistern drainage lonely on intraventricular cast hematoma and this treatment can reduce the risk of intracranial infection and hydrocephalus complication.