脑室出血并发脑积水的风险评估与治疗

脑室出血（IVH）约占自发性颅内出血患者的1／3。脑室出血并发出血后脑积水（PHH）是导致不良预后的独立危险因素。在建立修订的Graeb评分标准之后，结合logistic回归分析法建立预测PHH发生概率的数学模型，发现修订的Graeb评分标准比原Graeb评分标准预测不同类型的IVH并发PHH发生更加科学适用。按PHH发生几率大小进行分组，比较各组外科引流与内科保守治疗的病死率，建立了IVH的临床三级治疗方案，即评分1～4分行内科治疗，5～9分者在做好外科引流准备的条件下保守治疗，10～12分者积极引流。同时还对脑室外引流的时间、并发症、引流管拔除等相关问题进行了讨论。

The Risk Assessment and Clinical Management of Hydrocephalus after Intraventricular Hemorrhage

Intraventricular hemorrhage(IVH) accounts for one third of spontaneously intracranial hemorrhage(ICH). Post-hemorrhagic hydrocephalus(PHH) is regarded as an independent risk factor for the poor outcome of IVH. The probability of PHH could be predicted more acceptive by using logistic regression model combind with the Modifi ed Graeb criteria(MGC) than the Graeb criteria only. By compared the mortality among the groups in which the patients accepted different treatments, three clinical protocols were set up. The patients in the group for MGC point from 1 to 4 would accept conservative treatment only; from 5 to 9 would accept conservative treatment with prepared operation of external ventricular drainage(EVD); and from 10 to 12 would accept the immediate operation of EVD. The other issues related to the operation of EVD will be discussed in this review.