侧脑室外引流治疗重型脑室出血的体会

目的探讨侧脑室外引流治疗重型脑室出血的临床效果。方法对42例重型脑室出血（Grarb≥5）患者行额角单侧或双侧侧脑室外引流术,17例术后应用尿激酶注入,并辅以其他综合治疗措施。结果25例脑室内积血基本消失,15例脑室内出血明显减少,2例再出血。完全恢复日常生活9例（21．4％）,部分恢复日常生活11例（26．2％）,生活需要照顾或护理8例（19．1％）。结论侧脑室外引流有利于减少继发性脑损害,降低梗阻性脑积水的发生,是治疗重型脑室出血的简单、安全、有效的措施。     

脑室外引流治疗重型脑室出血

自1998年开始，我科应用钻颅双侧脑室额角穿刺外引流及脑室内注入尿激酶溶解血块，同时行腰穿置管蛛网膜下腔引流治疗12例重型脑室出血病人，取得满意疗效，并提示在发病早期治疗是抢救成功的关键。     

双侧脑室引流治疗重度脑室出血

重度脑室出血多继发于高血压脑出血,临床表现险恶,愈后差,死亡率高。自1999年8月至今,我院应用双侧脑室引流并尿激酶冲洗的方法共治疗重度脑室出血21例,疗效满意,现报告如下。     

侧脑室外引流治疗重型高血压继发性脑室出血46例

目的探讨重型高血压继发性脑室出血的治疗方法. 方法超早期或早期采用双侧侧脑室穿刺引流、尿激酶侧脑室灌洗、脑脊液置换术等微创方法综合治疗46例重型高血压继发性脑室出血(Graeb评分＞8分). 结果 46例随访6个月～3年,生存39例(84.8%),经药物控制血压,无再出血,按日常生活能力(activity of daily living, ADL)分级:Ⅰ级19例,Ⅱ级8例,Ⅲ级7例,Ⅳ级2例,Ⅴ级3例. 结论保证脑脊液循环通畅,改善脑微循环是重型脑室出血救治成功的关键.双侧侧脑室外引流等综合治疗是治疗的有效手段.     

高血压脑室出血的脑室外引流治疗86例报道

目的探讨高血压脑室出血的脑室外引流治疗。方法86例高血压性脑室出血采用双侧脑室外引流加尿激酶冲洗,控制血压,维持水、电解质平衡。结果86例患者中有效率83.3%,死亡14例,病死率16.2%。结论行双侧脑室外引流是治疗高血压脑室出血的一种简便有效的治疗方法。     

脑室穿刺灌注尿激酶治疗脑室内出血

目的:探讨脑室出血的救治方法,以降低脑室出血的死亡率。方法:早期采用脑室穿刺置管持续外引流,同时尿激酶注入及早期改善脑部微循环等综合治疗。结果:本组38例,治愈16例,生活部分自理10例,生活不能自理4例,死亡8例。结论:早期改善脑脊液循环与脑微循环是治疗脑室出血成功的关键,尿激酶灌注治疗脑室出血是一种安全有效的方法。     

侧脑室尿激酶灌注腰大池持续引流治疗重型脑室出血

本院自1996年1月至2006年6月共收治52例重型脑室出血病例，采用侧脑室尿激酶灌注、腰大池持续引流等治疗，取得较好疗效。现报告如下。     

外引流加尿激酶注射治疗脑室出血

目的寻找治疗脑室出血的方法。方法对我科2003年9月～2008年9月收治的34例脑室出血的患者，采用脑室外引流加尿激酶注射治疗。结果治愈或好转28例，占82．4％。结论脑室外引流加尿激酶注射治疗安全有效，促进清醒，效果满意，值得推广。     

微创手术治疗重型自发脑室出血

目的探讨微创手术治疗重型脑室出血的临床价值. 方法回顾分析侧脑室额角入路微创手术治疗12例重型自发脑室出血的临床资料. 结果 12例GOS 预后分级:I级3例、II级1例、III级1例、IV级2例、V级5例.存活9例,其中5例恢复正常生活、3例偏瘫、1例植物状态生存;死亡3例. 结论早期微创手术治疗重型脑室出血可改善患者的预后、降低并发症.     

微创治疗重度脑室出血(附36例报告)

目的:研究重度脑室出血的疗效。方法:对36例重度脑室出血患者通YL-1型血肿粉碎针进行双侧脑室额角置管外引流及尿激酶灌注冲洗引流和终池脑脊液置管引流治疗。结果:CT显示脑室内血肿消除时间4～5天21例,6～7天9例,9～10天4例,平均6天,基本治愈16例,显著进步11例,进步3例,植物生存3例,死亡3例。结论:微创治疗重度脑室出血安全、简便、有效。     

穿刺引流术治疗脑室出血115例报告

目的探讨微创穿刺引流术治疗脑室出血的疗效。方法 2005年11月-2010年11月对115例CT确诊脑室出血,其中重型脑室出血25例,根据患者脑室出血部位和体积选择性穿刺侧脑室额角,采用双侧或单侧脑室引流,术后尿激酶灌注冲洗,直至脑脊液正常,头颅CT确认血肿消失。结果住院期间治愈或好转88例（76.5%）,植物状态11例,死亡16例。98例随访3-12个月,平均6个月：78例复查头颅CT示脑室大小正常,再出血8例,继发性脑积水5例,死亡7例。结论脑室穿刺引流联合尿激酶灌注冲洗,能尽快清除脑室系统及蛛网膜下腔积血,对降低病死率,提高患者术后生存质量有重要意义。     

Sudden death due to massive intraventricular hemorrhage into an unsuspected ependymoma

Intracranial neoplasms may be quiescent asymptomatically while growing insidiously until they impinge on vital stfuctures or, because of their vascularity, lead to massive intracranial hemorrhage. We present such a case in a 4-year-old, previously asymptomatic child, who bled into an ependymoma and died in less than 36 hours.     

Traumatic primary intraventricular hemorrhage

Two patients with primary intraventricular hemorrhage following mild head injury are presented. Both patients experienced a rapid loss of consciousness after a lucid interval following the head injury. Conray ventriculography or computerized tomography revealed intraventricular hematoma originating in the third ventricle and causing an obstructive hydrocephalus. Both patients made good recoveries promptly after ventricular drainage.     

延迟腰大池持续引流配合改良双侧脑室外引流在治疗脑室出血铸型中的应用体会

目的总结延迟腰大池置管持续引流配合改良双侧脑室钻孔引流在治疗脑室出血铸型中的疗效和经验。方法对55例脑室出血并铸型的患者行双侧脑室外引流和延迟留置腰大池管持续引流的疗效进行分析。结果本组55例中47例(85.5%)治疗成功,8例死亡,脑室内血肿清除时间5~7 d者12例,8~10 d者32例,三、四脑室内积血消失平均8 d。存活的47例中3例发生脑积水,2例发生颅内感染。结论该方法在提高救治成功率、降低致残率、减少颅内感染和脑积水的发生率及提高生存质量等方面有积极意义。     

Epileptic seizures in intracerebral hemorrhage: a clinical and prognostic study of 55 cases

Fifty-five cases of epileptic seizures associated with spontaneous intracerebral hemorrhage are reported. Seizures appeared as the first symptom in 23 patients, early (within two weeks after HI) in 18 and late (later than 2 weeks after HI) in 14. From the analysis of the observed cases we noticed that: 1) partial seizures were most frequent type (63%). These appeared mainly in cases with lobar hemorrhage above all; 2) development chronic epilepsy occurred frequently in the case of patients affected by late seizures. We compare our data with those reported in literature in order to highlight main factors which affect the onset and development of seizures associated with spontaneous intracerebral haemorrhage.     

Safety and efficacy of extra-ventricular drainage combined with urokinase administration in the management of intraventricular hemorrhage

BackgroundIntraventricular hemorrhage (IVH) is a severe form of stroke. Studies of existing treatment options are controversial. Therefore, we aimed to evaluate the safety and efficacy of extra ventricular drainage (EVD) combined with uPA administration for the treatment of IVH.MethodsThe clinical data of 157 IVH patients admitted to our department during 2019-2022 were retrospectively analyzed. Based on the Glasgow Outcome Score (GOS) after 30 days, patients were categorized into favorable outcome (GOS4-5) and poor outcome (GOS1-3), and factors with prognostic impact were screened by univariate and multifactorial analysis, followed by propensity score matching and screening of paired patients for comparative analysis between the uPA and non-uPA groups.ResultsPatient age, uPA use, initial GCS score, and intracranial hematoma volume can all influence the patient's GOS. After propensity score-matched screening, 72 patients were finally included, 36 each in the uPA and non-uPA groups. Analysis revealed that at the follow-up after 30 days, 50.0% of patients with a GOS score of 4-5 were in the uPA group compared with 30.6% in the non-uPA group; however, they were not statistically significantly different. In contrast, the mean clearance of hematoma after four days was significantly higher in the uPA group than in the non-uPA group (P < 0.05) and did not increase the incidence of postoperative complications (P > 0.05).ConclusionuPA treatment may eliminate hematomas faster and reduce the rate of obstruction. However, its effectiveness in improving patient prognosis does not appear to be significant. Therefore, studies with larger samples may be needed to further validate its effectiveness.     

Intracranial hemorrhage secondary to von Willebrand's disease and trauma

A rare juvenile case of traumatic hemorrhage in the basal ganglia with intraventricular hematoma, associated with von Willebrand's disease, is reported. Hemostatic management of von Willebrand's disease and our surgical method for treatment of intraventricular hemorrhage are discussed briefly.     

神经内窥镜治疗原发性脑室出血

目的：探讨用微创技术治疗原发性脑室出血的新方法。方法：应用Karl-Storz硬质神经内窥镜治疗原发性脑室出血31例，其中单侧侧脑室为主的出血16例，双侧侧脑室为主的出血14例，三脑室合并四脑室出血1例。并发急性梗阻性脑积水者24例。结果：手术时间30-60min，平均43.4min。24例单、双侧脑室血肿清除90％以上，其余7例血肿清除50％-90％。术后明显好转和好转25例，无变化4例，死亡2例。1例术后并发脑积水。结论：应用神经内窥镜清除脑室内血肿，具有直视下操作、手术时间短、创伤小、血肿清除率高和术后疗效好等优点。     

腰大池灌注林格氏液加脑室外引流治疗脑室出血的实验研究

目的 探讨腰大池恒压灌注林格氏液加侧脑室外引流治疗脑室内出血的安全性、可行性及疗效。方法 选用纯种比格犬10条做成脑室内出血的模型，模型建立后4h开始治疗，实验组5条，以2．96kPa(1kPa＝7．5mm Hg)的压力经腰大池灌注林格氏液，同时行侧脑室外引流；对照组5条，用侧脑室外引流的方法。两组在治疗过程中均严格监测颅内压(ICP)及生命体征，记录引流量及灌注量，经12h的治疗后处死动物并收集脑室内全部残余积血，比较两组标本含铁血红蛋白的吸光度值。结果 两组动物从模型建立后至处死前生命体征平稳颅内压波动不太。经12h的治疗，实验组的引流量明显多于对照组(P＜0．05)，实验组脑内残余积血量明显少于对照组，两组差异有显著性(P＜0．05)。结论 以2．96kPa的压力恒压灌注林格氏液于腰大池内，同时行侧脑室外引流治疗脑室内出血的方法安全可行，能更快地消除脑室内积血。