脑室外引流联合腰大池引流治疗高血压脑室出血临床观察  

Clinical Observation of External Ventricular Drainage Combined with Lumbar Cistern Drainage in Treatment of Patients with Hypertensive Intraventricular Hemorrhage

作　　者：丁培源 张文川[2] 王旭辉[2] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院神经外科,上海202150 [2]上海交通大学医学院附属新华医院神经外科,上海200092

出　　处：《解放军医药杂志》2017年第11期22-25,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：上海市卫生和计划生育委员会科研课题计划(201440494);上海市崇明卫生局科研项目(CW2013-01)

摘　　要：目的探讨脑室外引流联合腰大池引流治疗高血压脑室出血(HIVH)临床疗效及对日常生活能力和认知功能的影响。方法选择2014年7月—2016年7月上海交通大学医学院附属新华医院崇明分院神经外科诊治的HIVH患者100例,按照治疗方法不同分为对照组及观察组,每组50例。对照组给予脑室外引流,观察组在对照组基础上联合腰大池引流。比较两组引流情况和血肿清除情况,实验室指标,疗效、转归和并发症发生情况,Barthel指数评分、简易智能精神状态检查量表(MMSE)及蒙特利尔认知评估量表(Mo CA)评分情况。结果观察组血肿清除率和总有效率高于对照组,血肿清除时间、脑脊液恢复正常时间、病死率和脑积水发生率均短于或低于对照组(P<0.05)。术后7 d,对照组C反应蛋白(CRP)低于治疗前,观察组同型半胱氨酸(Hcy)和CRP均低于治疗前和对照组(P<0.05)。出院3个月后,观察组Barthel指数、MMSE评分和Mo CA评分均高于对照组(P<0.05)。结论 HIVH患者行脑室外引流联合腰大池引流,可以提高疗效,降低病死率,且可改善日常生活能力和认知功能。Objective To investigate effectiveness of external ventricular drainage combined with lumbar cisterndrainage in treatment of patients with hypertensive intraventricular hemorrhage （ HIVH）and its effects on activity of dailyliving and cognitive function. Methods A total of 100 HIVH patients admitted during July 2014 and July 2016 were divided into control group （ n = 50）and observation group （ n = 50）according to different treatments. Control group wastreated with external ventricular drainage,while observation group was combined with lumbar cistern drainage on the basisof treatment for control group. Conditions of drainage,hematoma clearance,laboratory indexes,curative effect,turnover,complications,Barthel index score,minimental state examination （MMSE）score and Montreal cognitive assessment（MoCA）score were compared between the two groups. Results In observation group,hemorrhage clearance and the total effective rates were significantly higher,while values of hematoma clearance time,recovery time of cerebrospinal fluid,fatality rate and incidence rate of hydrocephalus were significantly lower than those in control group （ P 〈 0. 05） . Onpostoperative 7 d,C reactive protein （ CRP）level was significantly lower than that before treatment in control group,while homocysteine （ Hcy）and CRP levels were significantly lower than those before treatment in observation group （ P 〈0. 05） . In 3 months after discharging,values of Barthel index,MMSE and MoCA scores in observation group were significantly higher than those in control group （ P 〈 0. 05） . Conclusion External ventricular drainage combined with lumbarcistern drainage in treatment of patients with HIVH may improve curative effect,reduce fatality rate and improve activityof daily living and cognitive function.

关 键 词：高血压脑室出血 脑室外引流 腰大池引流 认知功能 

分 类 号：R743.34[医药卫生—神经病学与精神病学]