| 摘要: |
| 目的 探讨开颅血肿清除联合脑室外引流和单纯脑室外引流治疗高血压脑出血破入脑室的疗效。方法 回顾性分析2012年6月至2015年6月3年内我院收治的70例接受手术治疗的高血压脑出血破入脑室患者的临床资料，其中脑室外引流联合开颅血肿清除（EVD+HE组）患者31例，单纯脑室外引流（EVD组）39例。比较两组患者的格拉斯哥昏迷评分（GCS）、神经外科重症监护室（NICU）住院天数、死亡率、肺部感染、颅内感染和再出血的发生率以及随访6个月后的改良Rankin量表（mRS）评分及格拉斯哥预后评分（GOS）。然后筛选比较两组中幕上血肿量>30 mL患者的上述临床指标。结果 术后住院期间EVD+HE组9例（29.0%）患者死亡，EVD组2例（5.1%）死亡，差异有统计学意义（P=0.008）；其余存活患者继续纳入后续研究。EVD+HE组患者GCS评分增加值（ΔGCS）大于EVD组（P<0.05）；两组患者NICU住院时间，术后再出血及肺部感染、颅内感染发生率，随访6个月后mRS及GOS评分的差异无统计学意义（P>0.05）。EVD+HE组幕上血肿量>30 mL的患者ΔGCS、术后6个月mRS及GOS评分均优于EVD组（P<0.05），但NICU住院时间、术后再出血及肺部感染、颅内感染发生率与EVD组相比差异无统计学意义（P>0.05）。结论 对于幕上血肿量>30 mL的患者，开颅血肿清除联合脑室外引流术疗效优于单纯脑室外引流术。 |
| 关键词: 脑出血 高血压 脑室外引流 脑室内出血 血肿清除 |
| DOI：10.16781/j.0258-879x.2017.04.0515 |
| 投稿时间：2016-10-14修订日期：2017-02-27 |
| 基金项目:国家自然科学基金（81371382），上海市"领军人才"计划（2012049），上海市科技人才计划（15XD1504700）. |
|
| Curative effect of hematoma evacuation combined with external ventricular drainage in treatment of patients with intraventricular hemorrhage secondary to hypertensive intracerebral hemorrhage |
| CHEN Rong-bin,WEI Jia-liang,DONG Yan,WANG Jun-yu,HAN Kai-wei,YU Ming-kun,HUANG Cheng-guang,HOU Li-jun* |
(Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the curative effects of hematoma evacuation (HE) combined with external ventricular drainage (EVD) and simple EVD in the treatment of patients with intraventricular hemorrhage secondary to hypertensive intracerebral hemorrhage (HICH). Methods We retrospectively analyzed the clinical data of 70 patients who were diagnosed with HICH from Jun. 2012 to Jun. 2015 in Changzheng Hospital of Second Military Medical University. The patients were divided into EVD combined with HE group (EVD+HE group, n=31) and EVD group (n=39) according to the different choices of operation. The Glasgow Coma Scale (GCS) score, length of neurointensive intensive care units (NICU) stays, in-hospital mortality, incidences of lung infection, intracranial infection and rebleeding, and modified Rankin Scale (mRS) scores and Glasgow Outcome Scale (GOS) scores after 6 months were compared between two groups. Then we screened the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group (n=20) and EVD group (n=13), and compared the above clinical indicators between two groups. Results The in-hospital mortality rate of patients in the EVD+HE group was significantly higher than that in the EVD group (29.0% vs 5.1%, P=0.008). The survival patients were included in the subsequent research, including 22 cases in the EVD+HE group and 37 in the EVD group. The improved GCS (ΔGCS) scores of survival patients in the EVD+HE group was significantly higher than that in the EVD group (3.9±3.5 vs 1.2±3.3, P<0.05). The length of NICU stays, incidences of lung infection, intracranial infection and rebleeding, and mRS scores and GOS scores after 6 months of survival patients were not significantly different between the EVD+HE group and EVD group (P>0.05). After screening, the patients with supratentorial hematoma volume greater than 30 mL in the EVD+HE group had significantly higher improved GCS (ΔGCS) scores (3.8±4.0 vs 1.1±2.4, P=0.044), lower 6-month mRS scores (4.2±1.6 vs 5.3±0.7, P=0.025) and higher 6-month GOS scores (3.1±2.0 vs 1.7±0.7, P=0.030) than those in the EVD group. The length of NICU stays, incidences of rebleeding, lung infection and intracranial infection of patients were not significantly different between the EVD+HE and EVD groups (P>0.05). Conclusion For patients with supratentorial hematoma volume greater than 30 mL, HE combined with EVD is superior to simple EVD in treating intraventricular hemorrhage secondary to hypertensive intracranial hemorrhage. |
| Key words: cerebral hemorrhage hypertension external ventricular drainage intraventricular hemorrhage hematoma evacuation |
