密闭式侧脑室和腰池交替循环引流置换术治疗重度脑室出血的疗效探讨  

Therapentic effect of closed lateral ventricle and lumbar cistern alternant circulation drainage combined with cerebrospinal fluid replacement for severe cerebroventricular haemorrhage

作　　者：罗日向 李次发 温德树 马莉琴 吴志武 谢姚屹 兰晓艳 丘宇 

机构地区：[1]南宁市第三人民医院脑系科,广西530003

出　　处：《中国临床新医学》2012年第11期1004-1008,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫生厅科研课题(编号:Z2006270)

摘　　要：目的探讨应用密闭式引流置换装置行侧脑室和腰池交替循环引流置换术治疗重度脑室出血的疗效。方法将145例重度脑室出血患者随机分成两组,治疗组(71例)采用密闭式侧脑室和腰池交替循环引流置换术治疗,对照组(74例)应用传统侧脑室引流加腰穿脑脊液置换术治疗。观察两组的神经功能缺损评分(NIHSS)、日常生活活动能力评分(ADL)、意识障碍评分(GCS)、蛛网膜下腔血液廓清时间、住院时间、病死率及并发症等。结果治疗组NIHSS为(7.09±5.53)、ADL为(85.82±15.53)、GCS为(13.18±1.17);对照组NIHSS为(15.91±7.26)、ADL为(53.86±13.39)、GCS为(10.05±1.46),治疗组均优于对照组(P<0.01);治疗组并发脑积水和脑血管痉挛发生率为36.6%(26/71),死亡11例(15.5%),低于对照组的59.46%(44/74)和24例(32.4%)(P<0.05);治疗组患者蛛网膜下腔血液廓清时间为(5±1.9)d、住院时间为(23±4.7)d,低于对照组的(14±2.5)d和(35±5.8)d(P<0.01)。结论密闭式侧脑室和腰池交替循环引流置换术治疗重度脑室出血可明显降低患者的病死率和致残率,减少并发症和缩短住院时间,提高患者的生活质量。Objective To investigate the effect of closed lateral ventricle and lunbar cistern alternant circulation drainage combined with cerebrospinal fluid replacement for severe cerebroventricular haemorrhage （ CVH ）. Methods One hundred and forty-five patients with severe CVH were randomly divided into two groups：treatment group （n = 71, treated by closed lateral ventricle and lunbar cistern alternant circulation drainage combined with cere- brospinal fluid replacement） , control group （n = 74, treated by traditional lateral ventricle drainage combined with lumbar centesis）. The observation indexes included National Institutes of Health Stroke Scale（ NIHSS）, activities of daily living （ADL）, Glasgow Coma Scale（GCS） ,Subarachnoid blood clearance time ,days in hospital, mortality rate and complication. Results After the treatment, NIHSS,ADL and GCS in the treatment group were （7.09 ± 5.53 ）, （ 85.82 ± 15.53 ）, （ 13.18 ± 1.17 ）, and those in the control group were （ 15.91 ± 7. 26）, （53. 86 ± 13.39）, （ 10. 05 ± 1.46） respectively. There were significant differences in them between both groups（P 〈 0. 01 ）. In the treatment group, incidence of cerebral vasospasm and hydrocephalus was 36.6 % （ 26/71 ）, and 11 cases （ 15.5 % ） died, which was lower than that of the control group [ 59.46% （44/74） and 24 cases （ 32. 4% ） ]. There were also significant differences in them between two group（P 〈0.05）. The subarachnoid blood clearance time （5 ± 1.9） d and days in hospital （23 ±4. 7）d in treatment group were lower than those in the control group[ （ 14 ±2. 5 d）, （ 35 ±5.8 d） ]. There were significant differences in them between the groups （ P 〈 0.05 ）. Conclusion Closed lateral ventricle and lunbar cistern alternant circulation drainage combined with cerebmspinal fluid replacement for severe CVH can distinctly reduce mortality and disability rate, complication and days in hospital, and improve patients＇ living abihty.

关 键 词：脑室出血 密闭式引流 侧脑室和腰池 脑脊液置换 疗效 

分 类 号：R743.35[医药卫生—神经病学与精神病学]