穿刺引流治疗幕上脑出血:引流管位置的影响

Puncture and drainage for the treatment of supratentorial intracerebral hemorrhage:Influence of the drainage tube position

目的探讨在接受血肿穿刺引流术联合尿激酶治疗幕上脑出血的病人中,引流管位置对引流效果及短期预后的影响。方法回顾性分析135例接受血肿穿刺引流术联合尿激酶治疗的幕上脑出血病人的临床资料,以相对偏离度(relative deviation,RD)作为引流管位置指标,比较置管靠近血肿中心组(中心组)和靠近血肿边缘组(边缘组)的引流效果、并发症及短期预后差异。结果与边缘组比较,中心组残留血肿体积更少(P=0.038),血肿清除率更高(P=0.003),而两组术后并发症及短期预后均无显著差异(P>0.05)。在合并脑室出血病人中,中心组血肿清除率亦明显高于边缘组(P=0.001),但联合脑室外引流并不会提高血肿清除率(P>0.05),而颅内感染率明显升高(P<0.001)。结论采用血肿穿刺引流术联合尿激酶治疗幕上脑出血,手术置管靠近血肿中心引流效果更好,对合并脑室出血的病人尤为明显;但引流管位置不影响手术相关并发症,也不改变短期预后。

Objective To explore the influence of drainage tube position on drainage effect and short-term prognosis in patients with supratentorial intracerebral hemorrhage(ICH)undergoing puncture and drainage combined with urokinase(PD-U).Methods Clinical data of 135 supratentorial ICH patients receiving PD-U were analyzed retrospectively.The relative deviation(RD)was used as the indicator of drainage tube position,then,the differences of drainage effect,complications and short-term prognosis were compared between the group with catheterization near the center of hematoma(central group)and the group with catheterization near the margin of hematoma(marginal group).Results Compared with the marginal position,the residue hematoma volume was lower(P=0.038)and the hematoma evacuation rate was higher(P=0.003)in the central group.While no significant differences in the postoperative complications and short-term prognosis were found between the two groups(P>0.05).In patients with ventricular hemorrhage,the hematoma evacuation rate in the central group was significantly higher than that in the marginal group(P=0.001),and combined with intraventricular drainage did not increase the hematoma evacuation rate(P>0.05),while the rate of intracranial infection was significantly elevated(P<0.001).Conclusions With catheterization near the center of hematoma has a better drainage effect for supratentorial ICH patients receiving PD-U,especially for patients with intraventricular hemorrhage.However,the position of drainage tube does not affect the surgery-related complications or change the short-term prognosis.