重型脑室出血脑室外引流与保守治疗出院结局的回顾性分析

Retrospective analysis of the discharge outcome of external ventricular drainage and conservative treatment in patients with severe intraventricular hemorrhage

目的回顾性分析重型脑室出血（SeIVH）脑室外引流（EVD）与保守治疗的出院结局。方法从2011年1月至2016年12月入住火箭军总医院、陆军总医院及第三军医大学附属新桥医院的SeIVH患者中检索接受EVD治疗者，作为治疗组；并从接受保守治疗的SeIVH患者中根据脑室出血量和年龄按照1∶1随机匹配出对照组。比较不同的治疗方法是否会影响出院时发生中度及以下程度残障（mRS ≤3分）或者死亡（mRS 6分）的结局。结果6年间连续收治361例SeIVH患者。其中75例为治疗组；286例保守治疗者中匹配出75例为对照组。入院时两组脑室出血量分别为（55.8±22.7）ml和（53.7±23.3）ml（P＝0.569）、脑实质出血量分别为（23.6±5.3）ml和（24.0±5.4）ml（P＝0.631）、中位格拉斯哥昏迷评分（GCS）分别为4（1/4和3/4四分位数分别为3和7）和5（1/4和3/4四分位数分别为4和7）（P＝0.131）。出院时治疗组mRS≤3分的患者比例为16%（12/75），对照组为2.7%（2/75），两组比较P〈0.005，绝对危险度降低（ARR）了13.3%，获益1例所需治疗例数（NNT）为7.5；治疗组的死亡率为13.3%（10/75），对照组为41.1%（31/75）,两组比较P〈0.001，ARR为27.8%，NNT为3.6。结论尽管SeIVH的预后差，但与保守治疗相比较EVD治疗明显改善了这类患者的出院结局。开展验证EVD疗效的随机对照研究是需要的。

ObjectiveTo investigate the discharge outcome of external ventricular drainage（EVD） and conservative treatment in patients with severe intraventricular hemorrhage （SeIVH）.MethodsFrom January 2011 to December 2016, patients with SeIVH admitted to the General Hospital of the PLA Rocket Force and the Army General Hospital received EVD treatment and were classified as the treatment group. According to intraventricular hemorrhage volume and age, patients received conservative treatment were pair matched and classified as control group. Then we compared the clinical outcome of moderate disability or less degree of discharge （mRS ≤3） and death incidence （mRS 6） between two groups. ResultsA total of 361 patients with IVH were treated during these six years. Among them, 75 cases were chosen as treatment group. Another 75 cases were pair matched as control group from 286 cases. At the time of admission, the ventricular hemorrhage volume of two groups were （55.8±22.7） ml and （53.7±23.3） ml （P=0.569） respectively. Cerebral hemorrhage volume were （23.6±5.3） ml and （24.0±5.4） ml （P=0.631）. And the median Glasgow coma score （GCS） were 4[IQR（3, 7）] and 5[IQR（4, 7）]（P=0.131）. At the discharge time, there were 16% （12/75） patients scored mRS≤3 in treatment group, while 2.7% （2/75） in control group （P〈0.005）. The absolute risk reduction （ARR） was 13.3%, and the number needed to treat （NNT） was 7.5. The mortality rate of treatment group was 13.3% （10/75）, much lower than that of the control group 41.1% （31/75, P〈0.001）. ARR was 27.8% and NNT was 3.6.ConclusionAlthough the prognosis of SeIVH was poor, compared with conservative treatment, EVD treatment significantly improved the outcome of these patients. Randomized controlled trials are needed to validate the efficacy of EVD.