神经内镜清除血肿及三脑室底造瘘治疗脑室出血的疗效分析

Treatment of intraventricular hemorrhage by neuroendoscopic removal of hematoma and tri-ventriculostomy

目的观察应用神经内镜清除血肿及三脑室底造瘘在脑室出血中的治疗效果。方法选取2016-06-2017-06在郑州大学附属郑州中心医院诊治的脑室出血患者63例为研究对象,根据治疗方法不同分为内镜组和钻孔组,观察对比2组术后8 h CT的Graeb评分、注射尿激酶次数、拔管时间、术后颅内感染发生率、术后脑积水率、术后6个月患者的神经功能恢复的状况(mRS),分析应用神经内镜清除血肿及三脑室底造瘘在脑室出血中的治疗效果。结果内镜组术后8 h Graeb评分(4.060 6±1.390 6)分,钻孔组(9.5±1.634 8)分,差异有统计学意义(P<0.05);内镜组注药次数(1.39±1.029)次,钻孔组(6.43±1.851)次,差异有统计学意义(P<0.05);内镜组拔管时间(2.52±0.795)d,钻孔组(5.5±1.167)d,差异有统计学意义(P<0.05);术后内镜组发生颅内感染1例(3.03%),钻孔组5例(16.67%),差异无统计学意义(P>0.05)。内镜组出现脑积水1例(3.03%),钻孔组6例(20%),差异有统计学意义(P<0.05)。内镜组mRS评分优于钻孔组,差异有统计学意义(P<0.05)。结论应用神经内镜清除脑室血肿+三脑室底造瘘术治疗脑室出血能够快速清除脑室血肿,减少尿激酶脑室内注射次数、缩短拔管时间、减少术后颅内感染及脑积水的发生,能够改善患者的预后,提高患者生活质量。

Objective To observe the therapeutic effect of neuroendoscopic removal of hematoma and tri-ventriculostomy in intraventricular hemorrhage.Methods 63 patients with ventricular hemorrhage who were diagnosed and treated in Zhengzhou central hospital affiliated to zhengzhou university from June 2016 to June 2017 were selected as research objects.The patients were divided into endoscopic group and drilling group according to different treatment methods.The Graeb score at 8h postoperative,times of urokinase injections,extubation time,incidence of intracranial infection,hydrocephalus rate,and neurological function(mRS)of postoperative half a year of the patients in the two groups were observed and compared.The therapeutic effect of neuroendoscopic removal of hematoma and triventriculostomy in ventricular hemorrhage were analyzed.Results Postoperative 8hGraeb score(4.060 6±1.390 6)in the endoscopic group and(9.5±1.634 8)in the drilling group showed statistically significant difference(P<0.05).The Times of drug injection in the endoscopic group(1.39±1.029)and those in the drilling group(6.43±1.851)were statistically significant(P<0.05).The extubation time(2.52±0.795)d of the endoscopic group and the time(5.5±1.167)d of the drilling group,the difference was statistically significant(P<0.05).Intracranial infection occurred in 1 case(3.03%)in the endoscopic group and 5 cases(16.67%)in the drilling group,and the difference was not statistically significant(P>0.05).Hydrocephalus occurred in 1 case(3.03%)in the endoscopic group and 6 cases(20%)in the drilling group,and the difference was statistically significant(P<0.05).The mRS score of the endoscopic group was better than that of the drilling group,and the difference was statistically significant(P<0.05).Conclusion The treatment of intraventricular hemorrhage with neuroendoscopic removal of intraventricular hematoma + triple ventriculostomy can rapidly clear ventricular hematoma,reduce the number of urokinase intracranial injections,shorten the time of extubation,reduce postoperative intracranial infection and hydrocephalus,and improve the prognosis and quality of life of patients.