脑室外引流术在原发性脑室出血中的应用  

Application of external ventricular drainage in primary intraventricular hemorrhage

作　　者：战文建 解哨 吕岳 王杰 ZHAN Wen-jian;XIE Shao;LYU Yue(Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002, China)

机构地区：[1]徐州医科大学附属医院神经外科,221002 [2]徐州医科大学研究生院,221004

出　　处：《中国实用医药》2018年第36期26-28,共3页China Practical Medicine

摘　　要：目的评价脑室外引流术治疗原发性脑室出血的疗效。方法回顾性分析30例行脑室外引流术的原发性脑室出血患者的临床资料,观察患者术后引流管放置时间、术后血肿清除率、颅内感染发生率、死亡率、慢性脑积水情况及术后6个月日常生活能力。结果患者术后引流管保留时间最短4 d,最长11 d,平均时间6.2 d;根据拔管前头颅CT和术前头颅CT评估脑室内积血清除率最低61.0%,最高100.0%,平均清除率为79.5%;发生颅内感染7例,颅内感染发生率为23.3%;住院期间死亡7例,死亡率为23.3%;拔管后放置腰大池引流10例,用于引流血性及感染性脑脊液;术后6个月日常生活能力:治愈出院23例,失访3例,随访20例,其中恢复良好、生活自理17例,中度残疾2例,术后颅内感染并脑积水至死亡1例。结论脑室外引流术是治疗脑室出血的有效方法 ,脑室外引流术后给予尿激酶注射是引流脑室血肿、再通脑脊液循环通路、减少慢性脑积水发生的有效措施,术中及术后注意无菌操作是减少术后并发症的有效措施。Objective To evaluate the efficacy of external ventricular drainage in primary intraventricular hemorrhage. Methods The clinical data of 30 patients with primary intraventricular hemorrhage undergoing extraventricular drainage were retrospectively analyzed. The postoperative drainage tube placement time, postoperative hematoma clearance rate, incidence of intracranial infection, mortality, chronic hydrocephalus and daily living ability in postoperative 6 months were observed. Results Patients had shortest postoperative drainage tube retention time as 4 d, longest as 11 d, with mean time as 6.2 d. The lowest and highest serum removal rates were 61.0%, 100.0%, and the average clearance rate was 79.5% according to pre-extubation cranial CT and pre-extubation cranial CT. There were 7 cases of intracranial infection, with incidence of intracranial infection as 23.3%; 7 cases died during hospitalization, with mortality rate as 23.3%; 10 cases were treated with lumbar cistern drainage after extubation for drainage of hemorrhagic and infective cerebrospinal fluid. Activities of daily living in postoperative 6 months: 23 cases were cured and discharged from hospital, 3 cases were lost and 20 cases were followed up, including 17 cases recovered well and took care of themselves, 2 cases were moderately disabled, and 1 case died of intracranial infection and hydrocephalus after surgery. Conclusion External ventricular drainage is an effective method in the treatment of ventricular hemorrhage. Urokinase injection after ventricular drainage is an effective measure to drain ventricular hematoma, recanalize cerebrospinal fluid circulation pathway and reduce the occurrence of chronic hydrocephalus. Sterile operation during and after surgery is an effective measure to reduce postoperative complications.

关 键 词：脑室外引流术 原发性脑室出血 疗效 

分 类 号：R651.12[医药卫生—外科学]