脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血  

Treatment of severe primary intraventricular hematoma by ventriculoscope and continued lumbar cerebrospinal fluid drainage

作　　者：应建有[1] 谭占国[1] 袁波[1] 

机构地区：[1]河南省漯河市中心医院神经外科,漯河462000

出　　处：《中华神经创伤外科电子杂志》2015年第5期21-24,共4页Chinese Journal Of Neurotraumatic Surgery：Electronic Edition

摘　　要：目的评价脑室镜联合腰大池置管持续引流治疗重度脑室出血的疗效。方法回顾性分析2007年7月至2015年10月在漯河市中心医院神经外科收治的62例重度原发性脑室出血患者的临床资料,按时间先后顺序分为2组,其中A组（2010年5月以前）27例采用脑室钻孔引流及间断腰穿治疗,B组（2010年5月以后）35例应用脑室镜及腰大池置管持续引流治疗,分析患者术后48 h的血肿清除率及术后6个月患者日常生活能力ADL分级。结果 （1）A组27例中1例血肿清除〉90%,9例血肿清除60%-90%,17例血肿清除〈60%;B组35例中15血肿清除〉90%,18例血肿清除60%-90%,2例血肿清除〈60%,两组血肿清除率分布差异有统计学意义（P〈0.01）。（2）术后6个月随访,A组中ADLⅠ级5例,Ⅱ级8例,Ⅲ级6例,Ⅳ级6侧,Ⅴ级2例,恢复良好（ADLⅠ~Ⅲ级）有效率70.37%;B组中ADLⅠ级16例,Ⅱ级10例,Ⅲ级5例,Ⅳ级3例,Ⅴ级1例,恢复良好（ADLⅠ~Ⅲ级）有效率88.57%,两组间差异有统计学意义（P〈0.01）。结论应用脑室镜联合腰大池置管持续引流治疗重度原发性脑室出血具有血肿清除率高、后遗症发生率低等优点,是治疗重度原发性脑室出血较佳的方法。Objective To evaluate the efficacy of ventriculoscope and continued lumbar cerebrospinal fluid drainage in the treatment of severe primary intraventricular hematoma. Methods Sixty-two patients with severe primary intraventrieular hematoma patients in Luohe Central Hospital from July 2007 to November 2015 were retrospectively analyzed and divided into group A （n=27, before May 2010）and group B （n=35, after May 2010） according to the time sequence. Twenty-seven patients in group A were treated with ventriculopuncture and intermittent lumbar puncture. Thirty-five patients in group B were treated with ventriculoscope and continued lumbar cerebrospinal fluid drainage. Hematoma evacuation rate 48 hours after operation and ADL grades 6 months after operation were compared. Results （1）Hematoma evacuation rate 〉90% were found in 1 cases in group A 48 hours after operation, and hematoma evacuation rate 60%-90% were found in 9 cases, hematoma evacuation rate〈60% were found in 17 cases; Hematoma evacuation rate 〉90% were found in 15 cases in group A 48 hours after operation, and hematoma evacuation rate 60%-90% were found in 18 cases, hematoma evacuation rate 〈 60% were found in 2 cases, the differences were statistically significant （P〈0.01）. （2）6 months after operation, in group A, 5 cases of ADL grade Ⅰ , 8 cases of ADL grade Ⅱ, 6 cases of ADL grade Ⅲ, 6 cases of ADL grade Ⅳ, 2 case of ADL grade Ⅴ, good recovery rate was 70.37%; In group B, 16 cases of ADL grade Ⅰ, 10 cases of ADL grade Ⅱ, 5 cases of ADL grade Ⅲ, 3 cases of ADL grade Ⅳ, 1 case of ADL grade V, good recovery rate was 88.57%, the difference was statistically significant （P〈0.01）. Conclusion Ventriculoscope and continued lumbar cerebrospinal fluid drainage for severe primaryintraventricular hematoma is a better surgical treatment because of its effective hematoma evacuation and excellent postoperative outcome.

关 键 词：脑室镜 腰大池置管持续引流 重度原发性脑室出血 

分 类 号：R651.1[医药卫生—外科学]