颅内压监测下血肿钻洞外引流治疗基底节区脑出血效果观察

Trepanation and drainage for basal ganglia intracerebral hemorrhage under intracranial pressure monitoring

目的 探讨脑室内颅内压（intracranial pressure,ICP）监测下血肿钻孔外引流治疗基底节区脑出血的临床效果。方法 对42例未发生脑疝的基底节区脑出血患者（出血量25~50 ml）,选用配有ICP传感器的脑室导管套件进行脑室内ICP监测及脑室外引流,同期行钻洞血肿外引流,术后血肿腔内注射尿激酶促进积血溶解,并根据ICP情况给予相应治疗。结果38例患者术后复查血肿无扩大,其中16例在72 h内血肿大部分清除,12例在5 d内清除,10例在10 d内清除,均顺利拔除引流管;4例患者血肿扩大,其中2例血肿量仍〈40 ml,颅内压稳定,瞳孔无变化,继续引流后血肿大部分清除,2例血肿量较大转开颅手术;术后随访1个月,根据GOS评分,5分16例（38.1%）,4分18例（42.9%）,3分5例（11.9%）,2分1例（2.4%）,1分2例（4.8%）。结论 对未发生脑疝的基底节区脑出血患者,采用ICP监护及脑室外引流,结合钻洞血肿外引流,可有效降低颅内压,提高疗效,安全性高。

Objective To investigate the treatment effect of intracerebroventricular intracranial pressure （ICP） monitoring combined with the trepanation and drainage of hematoma for spontaneous basal ganglia hemorrhage. Methods Forty-two patients with Basal ganglia intracerebral hemorrhage （the bleeding amount from 25 ml to 50 ml） and without cerebral hernia were selected to this study. The trepanation and drainage of hematoma were performed simultaneously after extemal intraventricular drainage using the Micro Sensor Ventricular Catheter Kit （Codman） for each patient. Postoperatively, urokinase injection to hematoma cavity was used to dissolve and eliminate hematoma, and appropriate treatment was provided according to ICP. Results Postoperative CT scans showed that there was no hematoma enlargement in 38 patients. Among them, 16 cases exhibited gross-total removal of hematoma within 3 days postopera- tively, 12 cases within 5 days, 10 cases 10 days, and all of them had been through drainage withdrawn successfully. Although hematoma expansion was shown in 4 patients ,hematoma volume was still less than 40 ml in two cases,in which continuous drainage of hematoma cavity was performed for stable intracranial pressure and no pupillary change, and as a result gross-total hematoma was re- moved. Craniotomy was adopted in the additional two cases with hematoma expansion because of biggish hematomas. For all patients, there were not intracranial infection postoperatively. According to GOS score, follow-up which was continued for 1 months at least showed that 16 patients （38.1%） recovered well, 18 （42. 9% ） exhibited mild disability,5 （ 11.9% ） severe disability, 1 （2.4%） vegetative state and 2 （4. 8% ） death. Conclusion For the basal ganglia intracerebral hemorrhage patients without cerebral hernia, trepanation and drainage of hematoma combined with simultaneous external intraventricular drainage and ICP monitoring can reduce the ICP effectively, and improve therapeutic efficacy. Morever, continuous monitoring of ICP reduce the use of dehydration medicine and complications, thereby enhancing the safety of treatment.