两种不同方式引流术在脑室出血中的临床效果对比

Comparison of clinical efficacies of two different drainage methods in intraventricular hemorrhage

目的探讨Ommaya储液囊埋植引流术与微创脑室外引流术在脑室出血中的临床效果与安全性。方法选取2018年2月至2020年2月防城港市中医医院神经外科收治的脑室出血患者100例,随机分为A组与B组,每组各50例。A组患者接受Ommaya储液囊埋植引流术治疗,B组患者接受微创脑室外引流术治疗。检测术前、术后3 d两组患者血清神经元特异性烯醇化酶(NSE)与血清铁蛋白(SF)的水平,术后7 d使用格拉斯哥昏迷评分(GCS)对临床效果进行评价,术后3个月使用日常生活能力评分(ADL)对预后进行评价,并比较两组患者术后的副反应。结果接受不同措施干预后,两组患者血清NSE水平均较治疗前降低,而SF水平则较治疗前升高(P<0.05)。治疗后,A组患者NSE水平低于B组患者,SF水平高于B组患者(P<0.05)。A组患者术后7 d总有效率为94.00%,高于B组的76.00%(P<0.05)。两组患者副反应发生率和死亡率差异无统计学意义(P>0.05)。通过ADL评分评价预后显示,术后3个月A组患者中日常生活不能自理者比例低于B组患者(P<0.05)。结论与微创脑室外引流术相比,Ommaya储液囊埋植引流术治疗脑室出血患者能够更为有效地清除出血,对SF、NSE等脑损伤指标的改善效果也更加明显,综合治疗效果更好,且具有相当的安全性。作为一种疗效确切、操作简便的引流术式,具有一定临床价值。

Objective To investigate the clinical efficacy and safety of Ommaya reservoir implantation and drainage and minimally invasive extraventricular drainage in intraventricular hemorrhage.Methods A total of 100 patients with intraventricular hemorrhage admitted to the Department of Neurosurgery in Fangchenggang Traditional Chinese Medicine Hospital from February 2018 to February 2020 were selected and randomly divided into group A(n=50)and group B(n=50).Patients in group A were treated with Ommaya reservoir implantation and drainage,while those in group B were treated with minimally invasive extraventricular drainage.The levels of serum neuron-specific enolase(NSE)and serum ferritin(SF)were measured before and 3 days after operation.Glasgow coma scale(GCS)was used to evaluate the clinical efficacy after 7 days of operation,and activity of daily living(ADL)score was used to evaluate the prognosis after 3 months of operation.Meanwhile,the side effects of the two groups were compared.Results After treated with different intervention measures,the serum NSE levels of the two groups of patients were all lower than those before treatment,while the SF levels were higher than those before treatment(P<0.05).After treatment,NSE level in patients of group A was lower than that of group B,and SF level was higher than that of group B(P<0.05).The total effective rate of patients in group A was 94.00%after 7 days of operation,which was higher than 76.00%of the total effective rate of patients in group B(P<0.05).There were no statistically significant differences in side effects and mortality between the two groups of patients(P>0.05).Evaluation of prognosis by ADL score showed that the proportion of patients in group A who could not take care of themselves in daily life was lower than that in group B after 3 months of operation(P<0.05).Conclusion Compared with minimally invasive extraventricular drainage,Ommaya reservoir implantation and drainage are more effective in removing the hemorrhage,improving SF,NSE and other brain injury indices,and the comprehensive therapeutic efficacy is better and has considerable safety.As a kind of drainage method with definite therapeutic efficacy and simple operation,it has certain clinical value.