脑室出血合并脑积水行脑室外引流高危因素的临床分析

Clinical Analysis of Risk Factors for Hydrocephalus Patients after Intraventricular Hemorrhage in Exerting External Ventricular Drainage

目的:探讨脑室出血后未立即行脑室外引流术发生脑积水的指征和时机。方法:回顾性分析2009年1月到2015年9月我院收治的98例脑室内出血患者的临床资料。结果:98例患者中,28例(28.6%)患者需要行脑室外引流术。全脑室出血是最常见的类型(49例,50%),这些患者中24例(49%)需要行脑室外引流术。在脑室外引流术组和非脑室外引流术组平均m GS分别是17±5.1(12-28)和8±4.2(2-20)(P<0.001)。与脑室外引流术相关的因素包括影像学表现为脑积水、中线移位>5 mm、GCS评分<8分、m GS>13分、三脑室m GS=5及四脑室m GS=5分。多因素回归分析中,m GS>13分、GCS评分<8分和四脑室m GS=5分仍是重要的影响因素。大部分患者(24例,85.7%)在有脑积水症状时很快行脑室外引流术,有4例患者在48小时后行脑室外引流术。结论:昏迷、m GS>13分和四脑室扩大使行脑室外引流术的风险增大。大部分患者在脑室出血后一天内行脑室外引流术,很少一部分患者在48小时后行脑室外引流术。

Objective： To discuss and examine the indicators and time for hydrocephalus patients who were not immediately treated with external ventricular drainage （EVD） after intraventrieular hemorrhage （IVH）. Methods： Retrospective analysis of clinical data of 98 cases of IVH from January 2009 to september 2015. Results： Ninety-eight patients met the criteria; twenty-eight （28.6%） received EVD. Paraventricular hemorrhage was the most common pattern （49.5%）, with twenty-four in these patients requiring EVD. The median mGS in the EVD group was 17＋ 5.1 （12-28） and was 8＋ 4.2 （2-20） （p〈0.001） in the No-EVD group. Hydrocephalus diagnosed by imaging, midline shift 〉 5 mm, Glasgow Coma Scale （GCS） score〈 8, mGS 〉 13, third ventricle mGS = 5, and fourth ventricle mGS = 5 were associated with EVD. On multivariate regression analysis, mGS 〉13, GCS score〈 8 and fourth ventricle mGS = 5were still significant factors. Most patients （24, 85.7%） who were symptomatic hydrocephalus received EVD soon. Only four patients received EVD after forty-eight hours. Conclusions： Coma, mGS 〉13 and a dilated fourth ventricle increased the risk of EVD. Most patients experienced EVD within 24 hours after IVH, and a minority required EVD after 48 hours.