尿激酶经颅脑脊液置换治疗重症脑室出血的临床疗效观察

EFFICACY OF UROKINASE WITH DRILLING THE LATERAL VENTRICLE DRAINAGE FOR SEVERE INTRAVENTRICULAR HEMORRHAGE

目的观察尿激酶经颅脑脊液置换治疗重症脑室出血的临床疗效。方法治疗组对50例重症脑室出血患者均采用侧脑室前角钻孔引流术，术中应用尿激酶间断液化血肿引流。对照组采用传统性侧脑室钻孔引流术，单纯引流，不用尿激酶。分别从脑室积血吸收时间、脑积水发生率、术后神经功能恢复、病死率等方面进行比较。结果治疗组置管引流时间为3～7d，脑室积血清除率首次平均62％；术后1周平均89％；术后2周为100％，术后1个月发生脑积液1例。痊愈24例；显著进步15例；进步8例；死亡3例；总有效率94％。对照组置管引流时间为7～15d，脑室积血清除率首次为平均32％，术后1周为平均42％，术后2周为60％，100％清除率为0例，术后1个月发生脑积液5例。其中痊愈O例，显著进步13例，进步12例，死亡10例，自动出院15例。总有效率50％。结论经颅脑脊液置换术操作简便，在治疗重症脑室出血中创伤小，神经功能恢复快，可减少并发症。

Objective To observe the clinical efficacy of urokinase by drilling the lateral ventricle drainage in the treatment of severe intraventrieular hemorrhage. Methods The treatment group.. 50 patients with severe intraventricular hemorrhage patients were treated with drilled drainage angle of the lateral ventricle, intraoperative urokinase intermittent liquefied hematoma drainage. Control group： 50 patients received traditional drilling lateral ventricle drainage, drainaged without urokinase. The clinical efficacy of the two groups were compared from several aspects, include the absorbed time of hematocele, the incidence of hy- drocephalus, postoperative recovery of neurological function, mortality rates and other aspects. Results In the treatment group, the catheter drainage time was 3-7d, the average intraventricular hemorrhage clearance rate was 62% on the first time; the average rate was 89% after a week; the average rate was 100% after 2 weeks, hydrocephalus occurred in 1 case after a month. Cured patients were 24 cases; 15 cases were significantly progress and 8 cases were progress, 3 cases were dead; total effective rate was 94%. In the control group, the catheter drainage time was 7- 15d, the average intraventricular hemorrhage clearance rate was 32% on the first time; the average rate was 42%. after a week; the average rate was 60% after 2 weeks, hydrocephalus occurred in 5 cases after a month. No cured patient; 13 cases were significantly progress and 12 cases were progress; 10 cases were dead; 15 cases were discharged, total effective rate was 50%. Conclusions Transcranial cerebrospinal fluid replacement for severe intraventricular hemorrhage is less trauma, recovery of neurological function is quicker and reduce complications, it is simple and effective.