神经内镜辅助下治疗自发性脑室出血的疗效观察

Observation of curative effect of spontaneous intraventricular hemorrhage assisted by neuroendoscopy

目的探讨应用神经内镜治疗自发性脑出血的临床疗效。方法选择2014年9月~2018年9月我院神经外科手术治疗的自发性脑室出血患者56例,随机数字表法分为观察组和对照组各28例,观察组采用神经内镜下血肿清除+置管外引流术、对照组单纯行脑室穿刺外引流+尿激酶冲洗,以头颅CT评估术后48h血肿残留情况、置管时间、脑积水发生率、颅内感染率以及术后随访6个月观察患者日常生活能力(ADL)分级。结果①术后48 h观察组28例中16例血肿清除>90%、10例清除60%~90%、2例清除<60%;对照组:28例中2例血肿清除>90%、7例清除60%~90%、19例清除<60%,差异有显著的统计学意义(Z=7.180,P=0.000)②.观察组术后1例发生颅内感染(3.57%)、1例发生脑积水(3.57%)、1例再出血(3.57%)对照组术后3例发生颅内感染(10.71%)、4例发生脑积水(14.28%)、3例再出血(10.71%),治疗组发生不良反应3例(10.71%)、对照组10例(35.71%),两组差异有统计学意义(χ^2=4.909,P=0.027<0.05);③术后6个月随访观察患者日常生活能力(ADL)分级,观察组:ADLⅠ-Ⅱ级17例、Ⅲ级8例、Ⅳ级1例、Ⅴ级1例、死亡1例,恢复良好率89.29(25/28);对照组:ADLⅠ-Ⅱ级6例、Ⅲ级6例、Ⅳ级7例、Ⅴ级5例、死亡4例,恢复良好率42.86%(12/28),两组比较有统计学意义(χ^2=14.513,P=0.004)。结论神经内镜行脑室内血肿清除术较单纯置管尿激酶灌洗可明显降低脑室出血患者的致残率和致死率,减少并发症,缩短住院时间和病程,减轻家庭和社会负担,值得推广。

Objective To explore the clinical efficacy of neuroendoscopy in the treatment of spontaneous cerebral hemorrhage.Methods From September 2014 to September 2018,56 patients with spontaneous ventricular hemorrhage treated by neurosurgery in our hospital were randomly divided into an observation group and a control group of 28 cases.The observation group was cleared by neuroendoscopy and External catheter drainage,control group simply performed external ventricular puncture external drainage and urokinase flushing,using skull CT to evaluate the residual hematoma at 48 h after operation,catheterization time,incidence of hydrocephalus,intracranial infection rate and postoperative follow-up Observe the patient’s daily living ability(ADL)classification.Results①48 hours after operation,16 of 28 cases in the observation group had hematoma clearance>90%,10 cases had 60%~90%clearance,2 cases had<60%clearance;the control group:2 of 28 cases had hematoma clearance>90%and 7 cases had clearance 60%~90%,19 cases cleared<60%,the difference was statistically significant(Z=7.180,P=0.000).②1 case of intracranial infection(3.57%)and 1 case of brain occurred in the observation group after operation Hydrocephalus(3.57%),1 case of rebleeding(3.57%),3 cases of intracranial infection(10.71%),4 cases of hydrocephalus(14.28%),3 cases of rebleeding(10.71%)There were 3 cases(10.71%)of adverse reactions in the treatment group and 10 cases(35.71%)of the control group.The difference between the two groups was statistically significant(χ^2=4.909,P=0.027<0.05);Living Ability(ADL)classification,observation group:17 cases of ADL classⅠ-Ⅱ,8 cases of classⅢ,1 case of classⅣ,1 case of classⅤ,1 case of death,good recovery rate 89.29(25/28);control group:ADLⅠ-6 cases of gradeⅡ,6 cases of gradeⅢ,7 cases of gradeⅣ,5 cases of gradeⅤ,and 4 cases of death.The recovery rate was 42.86%(12/28).The comparison between the two groups was statistically significant(χ^2=14.513,P=0.004);Conclusion Neuroendoscopic intraventricular hematoma removal can significantly reduce the morbidity and mortality rate of patients with intraventricular hemorrhage,reduce complications,shorten hospitalization time and course of illness,and reduce family and social burdens.