基于脑脊液外引流治疗高血压性脑出血后分流依赖性脑积水发生的临床机制  

The Clinical Mechanism for the Occurrence of Shunt-Dependent Hydrocephalus after Cerebrospinal Fluid Drainage for Hypertensive Intracerebral Hemorrhage

作　　者：王立江[1] 朱磊 尹海斌 WANG Li-jiang;ZHU Lei;YIN Hai-bin(Department of Neurosurgery,the Seventh Affiliated Hospital of Southern Medical University,Foshan 528244,China)

机构地区：[1]南方医科大学第七附属医院神经外科,广东佛山528244

出　　处：《实用临床医学（江西）》2022年第3期18-23,I0003,共7页Practical Clinical Medicine

基　　金：佛山市医学科研课题(20200317)。

摘　　要：目的探讨基于脑脊液外引流治疗高血压性脑出血的临床疗效及影响分流依赖性脑积水发生的危险因素。方法回顾性分析61例脑脊液外引流治疗的高血压性脑出血破入脑室系统的患者临床资料,行脑室穿刺外引流术联合腰大池置管外引流术的患者为观察组(n=22),行单纯脑室穿刺外引流术或腰大池置管外引流术的患者为对照组(n=39),比较2组患者治疗后脑室积血Graeb评分改善程度和分流依赖性脑积水发生率;评价2组患者的年龄、性别、脑出血部位、发病时脑室积血Graeb评分、发病时GCS评分、有无急性脑积水、脑脊液外引流1周时脑室积血程度Graeb评分等因素,分析分流依赖性脑积水发生的危险因素。结果观察组发病时脑室积血Graeb评分明显高于对照组(P<0.05),观察组治疗后脑室积血Graeb评分改善程度明显优于对照组(P<0.05)。2组分流依赖性脑积水发生率比较差异无统计学意义(P>0.05)。发病时脑室积血Graeb评分、发病时GCS评分、脑脊液外引流1周时脑室积血Graeb评分对分流依赖性脑积水发生有影响(P<0.01或P<0.001)。多因素分析显示脑脊液外引流1周时脑室积血高Graeb评分是影响分流依赖性脑积水发生的独立危险因素。结论脑室穿刺外引流术联合腰大池置管术可显著改善脑室积血Graeb评分,脑脊液外引流1周时脑室积血高Graeb评分是预测分流依赖性脑积水发生的独立危险因素。Objective To investigate the clinical effect of cerebrospinal fluid drainage on hypertensive intracerebral hemorrhage and the risk factors for shunt-dependent hydrocephalus.Methods Clinical data of 61 patients who underwent cerebrospinal fluid drainage for rupture of hypertensive intracerebral hematoma into ventricular system were analyzed retrospectively.These patients were given ventricular drainage or external drainage of lumbar cistern alone(control group,39 cases)or their combination(observation group,22 cases).The improvement of Graeb score of intraventricular hemarrage and the incidence of shunt-dependent hyrocephalus were compared between the two groups.The age,gender,location of cerebral hemorrhage,Graeb and Glasgow coma scale(GCS)scores at onset,acute hydrocephalus,and Graeb score at 1 week of cerebrospinal fluid drainage were evaluated in both groups to analyze the risk factors for shunt-dependent hydrocephalus.Results The Graeb score at onset in the observation group was higher than that in the control group,and the improvement in the observation group was more significant than that in the control group after treatment(P<0.05).There was no significant difference in the occurrence of shunt-dependent hydrocephalus between the two groups(P>0.05).The Graeb and GCS scores at onset and the Graeb score at 1 week of cerebrospinal fluid drainage were associated with shunt-dependent hydrocephalus(P<0.01 or P<0.001).Multivariate analysis showed that the high Graeb score of intraventricular hemorrhage at 1 week of cerebrospinal fluid drainage was an independent risk factor for shunt-dependent hydrocephalus.Conclusion External ventricular drainage combined with lumbar cistern catheterization can effectively improve Graeb score of intraventricular hemorrhage.The Graeb score at 1 week of cerebrospinal fluid drainage is an independent risk factor for shunt-dependent hydrocephalus.

关 键 词：脑脊液外引流 高血压性脑出血 分流依赖性脑积水 脑室积血程度 

分 类 号：R743.34[医药卫生—神经病学与精神病学]