微创穿刺脑室外引流联合腰大池引流治疗破入脑室系统高血压性脑出血的临床效果

Clinical effects of Minimally invasive puncture extraventricular drainage combined with lumbar cistern drainage treatment of Hypertensive intracerebral hemorrhage breaking into ventricular system

目的:探讨微创穿刺脑室外引流(EVD)联合腰大池引流(CLD)治疗破入脑室系统高血压性脑出血(HICH)的临床效果及预后情况。方法:80例破入脑室系统HICH患者依据治疗方式不同分为A组(n=42)和B组(n=38),A组采用微创EVD联合CLD引流,B组采用单纯微创EVD引流。比较两组临床恢复情况、血肿清除效果、并发症及预后结果。结果:A组头痛持续时间、脑脊液转清时间、住院时间均短于B组,甘露醇用量少于B组(P<0.05);治疗后1、2、3、5 d,A组的残留血肿量均少于B组,血肿清除效果优于B组(P<0.05)。两组肺部感染、上消化道出血、再出血、颅内感染发生率比较,差异均无统计学意义(P>0.05),而A组脑积水发生率低于B组(P<0.05)。A组术后6个月日常生活能力(ADL)评分恢复情况优于B组(P<0.05),A组术后6个月格拉斯预后评分(GOS)恢复情况优于B组(P<0.05)。结论:EVD基础上联合CLD引流能快速有效清除HICH破入脑室患者血肿,减少甘露醇用量,缩短住院时间,降低脑积水发生风险,患者预后情况良好。

Objective:To observe the clinical effects and prognosis of Minimally invasive puncture extraventricular drainage(EVD)combined with lumbar cistern drainage(CLD)treatment of Hypertensive intracerebral hemorrhage breaking into ventricular system(HICH).Methods:80 patients were retrospectively analyzed by breach into ventricular system HICH.Patients were grouped according to treatment.42 patients with minimally invasive EVD combined with CLD drainage were included in group A,and 38 patients with simple minimally invasive EVD drainage were included in group B.The clinical recovery,the hematoma clearance effect,the occurrence of complications and the follow-up prognosis of the two groups were compared.Results:The headache duration,cerebrospinal fluid transduction time,and hospital stay in group A were shorter than those in group B,and the dosage of mannitol was less than that in group B(P<0.05).The amount of 1,2,3,and 5 d residual hematoma of the group A was less than that of the group B,and the blood and swelling effect was better than that of group B(P<0.05).There was no significant difference in the incidence of pulmonary infections,upper gastrointestinal bleeding,re-bleeding,intracranial infection between the two groups(P>0.05).The incidence of group A of cerebral water was lower than that in group B(P<0.05).After the group A follow-up 6 months,the daily life capacity(ADL)score recovery was superior to group B(P<0.05).After the group A follow-up 6 months,the resumption(GOS)recovery was superior to the group B(P<0.05).Conclusion:Theseearly results indicate that EVD basis Based on the combined CLD drain quickly and effectively cleared HICH to break into the endowed blood,reducing mannitol,shortening hospitalization time,reducing the risk of hydrocephalus,and patient prognosis.