用改良Graeb评分及GCS评分指导脑室出血的个体化治疗  

Individualized treatment of intraventricular hemorrhage guided by modified Graeb criteria score and Glasgow coma scale

作　　者：龙飞[1] 秦坤明[1] 廖声潮[1] 吴京展[1] 唐纯海[1] 刘涛[1] Long Fei;Qin Kunming;Liao Shengchao;Wu Jingzhan;Tang Chunhai;Liu Tao(Department of Neurosurgery,Second Affiliated Hospital of Guangxi Medical University,Nanning 530000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第二附属医院神经外科,南宁530000

出　　处：《中华危重病急救医学》2019年第11期1373-1377,共5页Chinese Critical Care Medicine

基　　金：广西壮族自治区医药卫生计划项目(Z20170091)。

摘　　要：目的探讨用改良Graeb评分及格拉斯哥昏迷评分(GCS)指导脑室出血个体化治疗方案的临床疗效。方法选择2014年6月至2018年2月广西医科大学第二附属医院神经外科收治的113例脑室出血患者,按照入院时GCS评分分为13~15分组、9~12分组和3~8分组;同时按照改良Graeb评分分为一级、二级、三级。在GCS评分9~12分和3~8分组中,若患者改良Graeb评分为三级,则施行双侧侧脑室外引流术;若改良Graeb评分为二级,则施行双侧侧脑室外引流术或腰大池引流术(9~12分组优先采取腰大池引流术,3~8分组优先采取脑室外引流术);若改良Graeb评分为一级则采取保守治疗。在GCS评分13~15分组中,若患者改良Graeb评分为三级,则施行双侧侧脑室外引流术或腰大池引流术;若改良Graeb评分为二级,则施行腰大池引流术或保守治疗;若改良Graeb评分为一级则采取保守治疗。观察患者个体化治疗后1个月GCS评分变化及治疗后6个月预后良好率〔预后良好定义为格拉斯哥预后评分(GOS)Ⅳ~Ⅴ级〕、脑室内血肿基本清除时间,以及颅内感染、肺部感染、脑积水等并发症发生情况。结果113例脑室出血患者均纳入最终分析,其中GCS评分13~15分组39例,9~12分组27例,3~8分组47例;修改Graeb评分一级21例,二级42例,三级50例。个体化治疗后1个月,GCS评分13~15分和9~12分组GCS评分均较入院时明显升高(分:14.8±0.2比13.7±0.8,13.1±1.7比10.7±1.1,均P<0.05);将同一患者入院时与治疗后1个月GCS评分配对比较,3组GCS评分均显著提高,说明入院时不同昏迷程度患者经个体化治疗后意识情况均得到显著改善。改良Graeb评分二级患者脑室内血肿基本清除时间为(7.0±2.8)d,三级患者为(6.1±2.0)d。个体化治疗后6个月,113例患者中GOS评分Ⅰ级7例(占6.2%),Ⅱ级13例(占11.5%),Ⅲ级28例(占24.8%),Ⅳ级27例(占23.9%),Ⅴ级38例(占33.6%);预后良好率57.5%(65/113)。113例患者发生颅内感染5�Objective To investigate the clinical effect of modified Graeb criteria score and Glasgow coma score(GCS)in individualized treatment of intraventricular hemorrhage.Methods 113 patients with intraventricular hemorrhage admitted to the department of neurosurgery of Second Affiliated Hospital of Guangxi Medical University from June 2014 to February 2018 were enrolled,and they were divided into 13-15,9-12,and 3-8 groups according to GCS score at admission,and modified Graeb criteria score was classified as gradeⅠ,Ⅱ and Ⅲat the same time.In GCS 9-12 and 3-8 groups,patients with modified Graeb criteria score gradeⅢwere treated with bilateral extra ventricular drainage,patients with modified Graeb criteria score grade Ⅱ were treated with bilateral extra ventricular drainage or lumbar cistern drainage(GCS 9-12 group was more prior to lumbar cistern drainage,3-8 group was given priority to extra ventricular drainage),and patients with modified Graeb criteria score gradeⅠwere treated conservatively.In GCS 13-15 group,bilateral extra ventricular cerebral drainage or lumbar cistern drainage was performed if the modified Graeb criteria score grade was Ⅲ,lumbar cistern drainage or conservative treatment was performed if the modified Graeb criteria score grade wasⅡ,and conservative treatment was performed if the modified Graeb criteria score grade wasⅠ.The changes in GCS score at 1 month after individualized treatment and the favourable prognosis rate at 6 months after treatment were observed[favourable prognosis was defined as Glasgow outcome score(GOS)Ⅳ-Ⅴ]as well as the basic clearance time of intraventricular hematomas,and the occurrence of complications such as intracranial infection,pulmonary infection and hydrocephalus were recorded.Results 113 patients with intraventricular hemorrhage were enrolled in the final analysis,including 39 patients in GCS 13-15 group,27 in 9-12 group,and 47 in 3-8 group;21 patients with the first grade of modified Graeb criteria score,42 with the second grade and 50 with t

关 键 词：改良Graeb评分 格拉斯哥昏迷评分 脑室出血 个体化治疗 

分 类 号：R651[医药卫生—外科学]