单纯脑室外引流与外引流联合尿激酶注射治疗脑室出血的对比分析

目的对比分析双侧或单侧单纯脑室外引流与外引流联合尿激酶注射治疗脑室出血的预后差异。方法收集该科自2004年1月—2012年1月收治的重症脑室出血患者202例并按治疗方法不同分为4组:单纯单侧脑室外引流组、单纯双侧脑室外引流组、单侧脑室外引流联合尿激酶灌注组和双侧脑室引流联合尿激酶灌洗组。脑室出血程度按Grarb评分进行分级。预后采用国际GOS评分进行评定。采用方差分析比较4组患者的预后和脑室积血完全清除时间的差异。结果双侧脑室引流联合尿激酶灌洗组患者的预后良好率显著高于单纯双侧脑室引流组与单纯单侧脑室引流组。脑室引流联合尿激酶灌洗组患者的出血完全清除时间显著低于单纯脑室引流组患者,差异有统计学意义(P0.001)。脑室引流联合尿激酶灌洗患者的住院费用均值显著低于单纯脑室引流患者(10 335.6元vs 18 165.1元,P=0.008),而与单纯脑室引流患者相比,脑室引流联合尿激酶灌洗患者的住院天数也显著减低(19.2 d vs 16.5 d,P=0.043)。结论双侧脑室引流联合尿激酶灌注不仅可以改善患者预后和减少脑室出血完全清除时间,而且还可以显著减低患者的急性期住院费用和住院天数,是一种经济有效的脑室出血治疗方法。

Impact of bilateral or unilateral external ventricular drainage and external ventricular drainage combined with urokinase instillation on the outcome of intraventricular hemorrhage

Objective To comparatively analyze the impact of bilateral or unilateral external ventricular drainage and external ventricular drainage combined with urokinase instillation on the outcome of intraventricular hemorrhage.Methods 202 cases of patients with intraventricular hemorrhage were collected during January 2004 to January 2012 and were divided into four groups by different treatments：single external ventricular drainage group,bilateral external ventricular drainage group,single external ventricular drainage combined with urokinase instillation group and the bilateral drainage combined with urokinase instillation group.The degree of intraventricular hemorrhage was assessed by Grarb score grading.The outcome was assessed by GOS score.ANOVA was used to compare the outcome and the complete clearance time of intraventricular hemorrhage among the four groups.Results The percentage of good outcome in bilateral drainage combined with urokinase instillation group was significantly higher than those of single external ventricular drainage group and bilateral external ventricular drainage group.The complete clearance time of intraventricular hemorrhage in drainage combined with urokinase instillation group was significantly shorter than that in external ventricular drainage group（P0.001）.The mean cost of hospitalization in patients with ventricular drainage combined urokinase instillation was significantly lower than that in patients with only ventricular drainage（10 335.6 vs 18 165.1,P=0.008）.Compared with patients with ventricular drainage alone,the length of stay in ventricular drainage combined with urokinase instillation was also significantly lower（19.2 vs 16.5,P=0.043）.Conclusion The bilateral drainage combined with urokinase instillation can not only improve patient outcome and reduce the complete clearance time of intraventricular hemorrhage,but also can significantly reduce the patient＇s acute hospitalization costs and length of stay,which is a cost-effective treatment for intraventricular hemorrhage.