侧脑室外引流不同部位对患者预后影响的研究

目的研究脑室出血血肿量多侧脑室引流与对侧脑室引流之间的差异，以及对患者预后的影响。方法所有患者侧脑室放置脑室外引流管，等脑内血肿稳定后开始经脑室引流管注射尿激酶，注射后夹闭引流管，1小时后开放。每日复查头颅CT，待第三脑室和第四脑室血肿在CT表现为完全清除后停止注射尿激酶。若引流液中无血性成分增加，予以夹闭引流管，24小时后若患者无明显不适，则拔除脑室外引流管。若患者需要长时间引流脑脊液或出现感染表现者，拔除脑室外引流管后，行腰大池引流。30天后评价患者病情，以改良Rankin量表（mRS）评分表示。结果共29名病例，同侧组18例，对侧组11例；两组在性别、年龄、入院时GCS评分和脑室血肿Graeb评分均无明显差异：同侧组脑内血肿和脑室血肿分别为11．72±4．40ml和36．67±14．82ml，对侧组分别为11．45±4．98ml和30．36±14．28ml，两组无明显差别；同侧组第三、第四脑室血肿清除时间（3．25±1．15天）要明显比对侧组少（4．10±0．77天，P=0．045），差异具有统计学意义：但是两组在导管留置时间、术后并发症以及30天mRS评分的比较上均无明显差异。结论脑室外引流管位于血肿同侧脑室时第三、第四脑室血肿清除的速度要快于引流管位于对侧；引流管放置位置对患者预后没有影响。

Research on the effects of external ventricular drain (EVD) with ipsilateral and contralateral ventricles to dominant lateral hemorrhage

Objective To investigate the different impact on outcomes of patients between external ventricular drain （EVD） ipsilateral and contralateral ventricles to dominant lateral hemorrhage. Methods All patients with obstructive hydrocephalus received EVD. When the hemotoma is stable, intraventrieular urokinase （UK） injection was applieated per 12 hours followed with a one-hour EVD clamping. Injection was not ceased un- til the entirely blood clearance from the third and forth ventricle on CT scan. When there was no increase of blood in visual from EVD, clamped the drainage tube for 24 hours and then removed it if there was no deterioration during the clamping hours. For the patients with worsen consciousness when the tube was clamped, which indicated the bad endurance of increased ICP, and for the patients with ventriculitis, lumbar drainage （LD） was needed. The outcome of all patients were evaluated 30 days after admission with modified Rankin Scale （mRS）. Results Totally 29 patients were included in this study, with 18 in ipsilateral group and 11 in contralateral group. There were no differences between two groups in gender and age, as well as in mRS and IVH Graeb Scale on admission. Stable volume of ICH in ipsilateral group and eontralateral group were 11.72_±4.40 ml and 11.45_± 4.98 ml respectively, which showed no difference between them. No difference could be seen in IVH volume, which was 36.67±14.82 ml in ipsilateral group and 30.36±14.28 ml in contralateral group. Significant difference was seen in the time of blood clearance from the third and forth ventricles on CT scan. In ipsilateral group it was 3.25±1.15 d while in eontralateral group it was 4.10±0.77 d. Other aspects including the time of drainage, complication and 30d-mRS showed no differences between two groups. Conclusion The blood clearance from third and forth ventricles in ipsilateral group was much rapid than in contralateral group. But EVD ipsilateral or contralateral ventricles to dominant lateral hemorrhage had no impact on outcome of patients.