脑室定位穿刺内窥镜下血肿清除联合脑室内灌洗治疗严重脑室内出血的效果分析  

Analysis of the effect of intraventricular positioning puncture endoscopic hematoma removal combined with intraventricular lavage in treatment of severe intraventricular hemorrhage

作　　者：林伟[1] 林振堃 林海峰 刘宇清[1] 洪文瑶[1] LIN Wei;LIN Zhenkun;LIN Haifeng(Department of Neurosurgery,Fujian Provincial Hospital,Fujian Province,Fuzhou 350001,China;不详)

机构地区：[1]福建省立医院神经外科,福州350001 [2]福建省莆田涵江医院(新院)神经外科

出　　处：《临床外科杂志》2021年第12期1119-1122,共4页Journal of Clinical Surgery

基　　金：福建医科大学教育教学改革研究项目(J19019)。

摘　　要：目的探讨脑室定位穿刺内窥镜下血肿清除联合脑室内灌洗治疗严重脑室内出血(IVH)的效果。方法前瞻性选取我院2019年2月~2020年2月收治的96例严重IVH病人为研究对象,根据治疗方法分为联合组和引流组,每组各48例;联合组予以脑室定位穿刺内窥镜下血肿清除联合脑室内灌洗治疗;引流组行脑室定位穿刺内窥镜下血肿清除术治疗。比较两组病人脑脊液引流量、血肿清除率、格拉斯哥昏迷评分(GCS)、预后及并发症发生情况。结果随访6个月后,联合组失访2例,引流组失访3例,最终联合组纳入46例,引流组纳入45例。联合组术后24小时、术后3天脑脊液引流量高于引流组,术后7天脑脊液引流量低于引流组,两组比较,差异有统计学意义(P<0.05);联合组术后6小时、1天、3天、7天血肿清除率高于引流组,术后1天、3天、7天GCS评分高于引流组,脑积水、颅内感染的发生率低于引流组,两组比较,差异有统计学意义(P<0.05),两组其余术后并发症发生率比较差异无统计学意义(P>0.05)。术后随访6个月,联合组预后不良发生率为8.70%(4/46),引流组为24.44%(11/45),预后不良发生风险联合组低于引流组(log-rankχ^(2)=4.593,P=0.032)。结论脑室定位穿刺内窥镜下血肿清除联合脑室内灌洗治疗严重IVH可有效提高脑脊液引流效率,提高血肿清除率,改善病人神经功能,改善病人预后,且能降低病人脑积水、颅内感染的发生率。Objective To investigate the effect of intraventricular positioning puncture endoscopic hematoma removal combined with intraventricular lavage in the treatment of severe intraventricular hemorrhage(IVH).Methods Prospectively selected 96 patients with severe IVH admitted to our hospital from February 2019 to February 2020 as the research objects.According to the treatment method,they were divided into a combination group and a drainage group,with 48 cases in each group;the combined group was treated with ventricular positioning puncture endoscopic hematoma removal combined with intraventricular lavage;the drainage group was treated with ventricular positioning puncture endoscopic hematoma removal treatment.After treatment,the cerebrospinal fluid drainage,hematoma clearance rate,Glasgow Coma Score(GCS),prognosis and complications were compared between the two groups.Results After 6 months of follow-up,2 cases were lost to follow-up in the combined group and 3 cases in the drainage group.Finally,46 severe IVH patients were included in the combined group and 45 severe IVH patients in the drainage group.The cerebrospinal fluid drainage at 24 hours and 3 d after surgery in the combined group was higher than that of the drainage group,and the 7 d postoperative cerebrospinal fluid drainage was lower than that of the drainage group(P<0.05);the hematoma clearance rate of the combined group was higher than that of the drainage group at 6 h,1 d,3 d,and 7 d after surgery(P<0.05).After 1 d,3 d,7 d,the GCS scores of the combined group were higher than those of the drainage group(P<0.05);the incidence of hydrocephalus and intracranial infection in the combined group was lower than that of the drainage group(P<0.05).There was no statistically significant difference in the rate of remaining postoperative complication rates between the groups(P>0.05).After 6 months of follow-up,the incidence of poor prognosis was 8.70%(4/46)in the combined group and 24.44%(11/45)in the drainage group.The risk of adverse outcome was lower in the com

关 键 词：脑室定位穿刺 血肿清除 脑室内灌洗 严重脑室内出血 

分 类 号：R651.1[医药卫生—外科学]