双侧侧脑室外引流并腰穿脑脊液置换治疗重型脑室出血15例.docVIP

双侧侧脑室外引流并腰穿脑脊液置换治疗重型脑室出血15例[摘要] 目的:探讨治疗重型脑室出血的有效治疗方法。方法:15例重型脑室出血患者行微创针穿刺及脑室内置入软管相结合术式行双侧侧脑室外引流术及脑室内灌注尿激酶、腰穿脑脊液置换、地塞米松鞘内注射。结果:12例存活,其中,良好4例,轻残6例,重残2例,植物状态1例,死亡2例。结论:微创针穿刺及脑室内置入软管相结合术式行双侧侧脑室外引流并腰穿脑脊液置换是一种治疗脑室出血的有效方法,可提高脑室出血患者的生存质量和生存率。 [关键词] 重型脑室出血;双侧侧脑室引流;微创针;软管;脑脊液置换 [中图分类号] R743.34 [文献标识码]A [文章编号]1674-4721(2010)06(a)-054-02 15 cases of severe intraventricular hemorrhage treatment with bilateral ventricle drainage and cerebrospinal fluid replacement CHEN Jian, PAN Jianhua, CHEN Zhen, YE Weibin, PENG Xuewen (Department of Neurosurgery, Wanjiang Hospital of Dongguan City,Guangdong Province,Dongguan 523050,China) [Abstract] Objective:To study the effective treatment of severe intraventricular hemorrhage. Methods:15 cases of severe intraventricular hemorrhage were treated by minimally invasive puncture, implantation of flexible hose in the ventricle, bilateral ventricle drainage, perfusion of urokinase in the ventricle, cerebrospinal fluid replacement and intrathecal injection of dexamethasone. Results:12 cases of survival, including 4 cases of good recovery, 6 cases of mildly disabled and 2 cases of severely disabled;1 case of vegetative patient; 2 cases of death. Conclusion: Minimally invasive puncture, implantation of flexible hose in the ventricle and bilateral ventricle drainage combined with cerebrospinal fluid replacement is an effective treatment for intraventricular hemorrhage, and which is also able to improve the life quality and survival rate. [Key words] Severe intraventricular hemorrhage;Bilateral ventricle drainage;Minimally invasive needle;Flexible hose;Cerebrospinal fluid replacement 脑室出血在临床常见,它是指非外伤因素导致颅内血管破裂,血液流入脑室系统引起的综合征,约占自发性颅内出血的20%～60%[1],临床死亡率高。本院于2004年5月～2009年12月采用微创针穿刺及脑室内置入软管相结合术式行双侧侧脑室外引流术,尿激酶脑室内灌注,早期腰穿脑脊液置换,鞘内注射地塞米松的治疗方法,治疗重型脑室出血患者15例,取得较好疗效,现报道如下: 1 资料与方法 1.1 一般资料 本院于2004年5月～2009年12月共收治15例自发性重型脑室出血患者,男 11例,女 4例,年龄45～78岁 ,平均59.5岁。全部患者均符合全国第四届脑血管病会议关于脑出血的诊断标准[2],合并原发性高血压病史者12例,合并冠心病病史者5例。 1.2 临床表现 入院时意