健、患侧脑室外引流术治疗高血压脑出血破入脑室与术后早期再出血对比研究(1)
摘要：目的 对比健侧与患侧脑室外引流术治疗高血压脑出血破入脑室与术后早期再出血的发生率。方法 回顾于2014年1月～2016年4月西南医科大学神经外科经单侧侧脑室外引流手术治疗的高血压脑出血破入脑室患者88例，根据患者穿刺部位将患者分为健侧组40例与患侧组48例，所有患者均于术前及术后24 h行头颅CT检查，通过2次CT对比，比较两组术后再出血的发生情况。结果 健侧组再出血5例，再出血率14.29%，患侧组再出血0例，再出血率0，健侧组术后再出血率高于患侧组(P<0.05)。结论 健侧侧脑室外引流治疗高血压脑出血破入脑室术后再出血发生率较患侧高。
关键词：脑室出血；健侧脑室；患侧脑室；脑室外引流；再出血
A Comparative Study on the Treatment of Hypertensive Cerebral Hemorrhage in Patients with Hypertensive Cerebral Hemorrhage in the Early Postoperative Rebleeding
, http://www.100md.com
YANG Pan，YANG Fu-bing
(Department of Neurosurgery，Affiliated Hospital of Southwest Medical University，Luzhou 646000，Sichuan，China)
Abstract：Objective To compare the incidence of hypertensive intracerebral hemorrhage in the ventricle and early postoperative rebleeding by contralateral and lateral ventricle drainage.Methods From January 2014 to April 2016，88 patients with hypertensive intracerebral hemorrhage treated by unilateral lateral ventricle drainage were enrolled in the department of Neurosurgery of Southwest Medical University，and the patients were divided into the contralateral group 40 according to the puncture site cases and 48 cases of ipsilateral group，all patients were preoperative and postoperative 24 h after head CT examination， through two CT contrast，compared the two groups after the occurrence of rebleeding.Results The contralateral group 5 cases of rebleeding，rebleeding rate 14.29%，ipsilateral group 0 cases of hemorrhage，bleeding rate was 0，the contralateral group postoperative rebleeding rate is higher than the ipsilateral group(P<0.05).Conclusion The contralateral ventricle drainage hemorrhage and rebleeding rate than the ipsilateral high breaking into ventricle after the treatment of hypertensive cerebral.
, 百拇医药
Key words：Ventricle hemorrhage；Contralateral ventricle；Ipsilateral ventricle；Extraventricular drainage；Rebleeding
高血壓脑出血(hypertensive cerebral hemorrhage，HICH)破入脑室是神经外科常见疾病，脑室外引流术是治疗HICH破入脑室常用方法。术后再出血是导致患者术后早期患者病情加重的常见原因。有相关文献报道HICH术后再出血约占5%～21%[1]。现就健侧、患侧单侧侧脑室外引流与术后再出血发生情况国内尚无人研究。本研究通过对比健、患侧脑室外引流术后再出血发生率评判两种手术方式对术后再出血的影响。
1 资料与方法
1.1一般资料 选择2014年1月～2016年4月西南医科大学(原泸州医学院)附属医院神经外科经单侧侧脑室外引流手术治疗的HICH破入脑室的患者88例为研究对象。患者均有明确高血压病史，均符合2014年中国脑出血诊治指南诊断标准，均行头颅CT提示基底节区或丘脑出血。其中男53例，女35例；年龄40～87岁，平均年龄(60.95±9.03)岁；基底节区出血30例，丘脑出血58例；发病到手术时间<6 h 36例，>6 h 52例；出血量9～39ml，平均(19.14±9.88)ml。排除标准：①小脑、脑干出血破入脑室者，瘤卒中、动静脉畸形、动脉瘤、外伤所致脑出血，原发性脑室出血者；②术后血压控制不满意者；③行双侧脑室外引流或脑室外引流合并开颅血肿清除术者。依据穿刺部位将88例患者分为健侧组40例，患侧组48例。
1.2方法 所有患者均行传统经额单侧侧脑室外引流术，根据患者是否有脑室铸型形成且脑室内血凝块是否占据整个侧脑室，如存在上述情况，为防止引流管堵塞部分采用健侧脑室外引流(大部分采用双侧脑室外引流)，余患者随机采用健侧或患侧引流，引流管放入深度为刚穿刺出脑脊液后再深入10 mm，术后引流管距脑室平面抬高15 cm，控制引流量200～300 ml/d，术后均常规止血、镇静、脱水、营养神经、控制血压、抗感染等药物治疗。, http://www.100md.com(杨攀 杨福兵)
关键词：脑室出血；健侧脑室；患侧脑室；脑室外引流；再出血
A Comparative Study on the Treatment of Hypertensive Cerebral Hemorrhage in Patients with Hypertensive Cerebral Hemorrhage in the Early Postoperative Rebleeding
, http://www.100md.com
YANG Pan，YANG Fu-bing
(Department of Neurosurgery，Affiliated Hospital of Southwest Medical University，Luzhou 646000，Sichuan，China)
Abstract：Objective To compare the incidence of hypertensive intracerebral hemorrhage in the ventricle and early postoperative rebleeding by contralateral and lateral ventricle drainage.Methods From January 2014 to April 2016，88 patients with hypertensive intracerebral hemorrhage treated by unilateral lateral ventricle drainage were enrolled in the department of Neurosurgery of Southwest Medical University，and the patients were divided into the contralateral group 40 according to the puncture site cases and 48 cases of ipsilateral group，all patients were preoperative and postoperative 24 h after head CT examination， through two CT contrast，compared the two groups after the occurrence of rebleeding.Results The contralateral group 5 cases of rebleeding，rebleeding rate 14.29%，ipsilateral group 0 cases of hemorrhage，bleeding rate was 0，the contralateral group postoperative rebleeding rate is higher than the ipsilateral group(P<0.05).Conclusion The contralateral ventricle drainage hemorrhage and rebleeding rate than the ipsilateral high breaking into ventricle after the treatment of hypertensive cerebral.
, 百拇医药
Key words：Ventricle hemorrhage；Contralateral ventricle；Ipsilateral ventricle；Extraventricular drainage；Rebleeding
高血壓脑出血(hypertensive cerebral hemorrhage，HICH)破入脑室是神经外科常见疾病，脑室外引流术是治疗HICH破入脑室常用方法。术后再出血是导致患者术后早期患者病情加重的常见原因。有相关文献报道HICH术后再出血约占5%～21%[1]。现就健侧、患侧单侧侧脑室外引流与术后再出血发生情况国内尚无人研究。本研究通过对比健、患侧脑室外引流术后再出血发生率评判两种手术方式对术后再出血的影响。
1 资料与方法
1.1一般资料 选择2014年1月～2016年4月西南医科大学(原泸州医学院)附属医院神经外科经单侧侧脑室外引流手术治疗的HICH破入脑室的患者88例为研究对象。患者均有明确高血压病史，均符合2014年中国脑出血诊治指南诊断标准，均行头颅CT提示基底节区或丘脑出血。其中男53例，女35例；年龄40～87岁，平均年龄(60.95±9.03)岁；基底节区出血30例，丘脑出血58例；发病到手术时间<6 h 36例，>6 h 52例；出血量9～39ml，平均(19.14±9.88)ml。排除标准：①小脑、脑干出血破入脑室者，瘤卒中、动静脉畸形、动脉瘤、外伤所致脑出血，原发性脑室出血者；②术后血压控制不满意者；③行双侧脑室外引流或脑室外引流合并开颅血肿清除术者。依据穿刺部位将88例患者分为健侧组40例，患侧组48例。
1.2方法 所有患者均行传统经额单侧侧脑室外引流术，根据患者是否有脑室铸型形成且脑室内血凝块是否占据整个侧脑室，如存在上述情况，为防止引流管堵塞部分采用健侧脑室外引流(大部分采用双侧脑室外引流)，余患者随机采用健侧或患侧引流，引流管放入深度为刚穿刺出脑脊液后再深入10 mm，术后引流管距脑室平面抬高15 cm，控制引流量200～300 ml/d，术后均常规止血、镇静、脱水、营养神经、控制血压、抗感染等药物治疗。, http://www.100md.com(杨攀 杨福兵)
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