CAJ | 학술논문

目的：在尿激酶脑室内溶栓（ IVF）治疗下，比较重度脑室内出血（ IVH）患者在进行单管或双管脑室外引流（ EVD）时的引流效率。方法选择2010-01～2013-06符合纳入标准的47例重度IVH患者随机分为单侧脑室外引流组（单管引流组）和双侧脑室外引流组（双管引流组），各组患者均接受同样的脑室内尿激酶溶栓方案，剂量为2万U q 12 h，双管引流组左右侧药物注入选择为随机；记录并比较脑室内溶栓前及溶栓后1、3、5、7 d时的平均每日脑脊液（ CSF ）引流量、颅内压（ICP）、GCS评分及ICU监护时间、脑室外引流管放置时间（IVC放置时间）、IVH体积、Graeb评分、颅内感染率，并随访比较发病后6个月时的GOS评分及病死率等。结果两组患者的基线IVH体积、初次Graeb评分、GCS评分、年龄及性别例数比较差异均无统计学意义（ P＞0.05），具有可比性。两组ICU监护时间和IVC放置时间比较差异无统计学意义（P＞0．05），平均每日CSF引流量比较差异有统计学意义（ P＜0．05），双管引流组平均每日CSF引流量更多。两组溶栓前及溶栓后1、3、5、7 d时IVH体积下降程度比较差异有统计学意义，双管引流组优于单管引流组（P＜0．05），而Graeb评分、ICP、GCS两组比较差异无统计学意义（P＞0．05）；两组引流期间均未发现颅内感染。随访比较6个月时的GOS评分（t＝12．63，P＝0．000）和病死率（χ2＝7．57， P＝0．006）发现，双管引流组明显优于单管引流组。结论对于严重、体积大的IVH，相同IVF治疗条件下，放置双管EVD引流较单管清除血肿效率更高，并能改善预后和降低病死率，且不增加颅内感染率和延长IVC放置时间及ICU监护时间。
목적：재뇨격매뇌실내용전（ IVF）치료하，비교중도뇌실내출혈（ IVH）환자재진행단관혹쌍관뇌실외인류（ EVD）시적인류효솔。방법선택2010-01～2013-06부합납입표준적47례중도IVH환자수궤분위단측뇌실외인류조（단관인류조）화쌍측뇌실외인류조（쌍관인류조），각조환자균접수동양적뇌실내뇨격매용전방안，제량위2만U q 12 h，쌍관인류조좌우측약물주입선택위수궤；기록병비교뇌실내용전전급용전후1、3、5、7 d시적평균매일뇌척액（ CSF ）인류량、로내압（ICP）、GCS평분급ICU감호시간、뇌실외인류관방치시간（IVC방치시간）、IVH체적、Graeb평분、로내감염솔，병수방비교발병후6개월시적GOS평분급병사솔등。결과량조환자적기선IVH체적、초차Graeb평분、GCS평분、년령급성별례수비교차이균무통계학의의（ P＞0.05），구유가비성。량조ICU감호시간화IVC방치시간비교차이무통계학의의（P＞0．05），평균매일CSF인류량비교차이유통계학의의（ P＜0．05），쌍관인류조평균매일CSF인류량경다。량조용전전급용전후1、3、5、7 d시IVH체적하강정도비교차이유통계학의의，쌍관인류조우우단관인류조（P＜0．05），이Graeb평분、ICP、GCS량조비교차이무통계학의의（P＞0．05）；량조인류기간균미발현로내감염。수방비교6개월시적GOS평분（t＝12．63，P＝0．000）화병사솔（χ2＝7．57， P＝0．006）발현，쌍관인류조명현우우단관인류조。결론대우엄중、체적대적IVH，상동IVF치료조건하，방치쌍관EVD인류교단관청제혈종효솔경고，병능개선예후화강저병사솔，차불증가로내감염솔화연장IVC방치시간급ICU감호시간。
Objective To compare the drainage efficiency in single or bilateral external ventricular drainage ( EVD ) under the intraventricular fibrinolysis ( IVF ) of urokinase in severe ventricular haemorrhage cases .Methods Forty seven patients with severe ventricular haemorrhage were came from Emergency Department and Neurosurgery Department , Shenzhen People's Hospital from January 2010 to June 2013 .The patients were divided into two groups: the single EVD group and the bilateral EVD group .Each patient accepted the same IVF therapy with urokinase 20000Uq 12h.The two groups were measured the average daily volume of CSF , intracranial pressure ( ICP) , GCS and ICU monitoring time, IVC placement time, IVH volume, Graeb scores, the rate of intracranial infection, etc before IVF and 1, 3, 5, 7 days after IVF.Statistical comparisons between groups were analyzed by using repeated measurement design analysis of variance and Student 's T test.The death rate and GOS score were recorded and compared in the six months after attacks .Results There were no statistically significant differences between the two groups with baseline IVH volume , initial Graeb score, GCS, age and gender .The ICU monitoring time and IVC placement time in two groups showed no statistical difference (P >0.05), the average daily CSF drainage were statistically significant different (P <0.05 ) , the bilateral EVD group average daily CSF was more than the single EVD group .The IVH volume decreased more significantly in the two groups , the bilateral EVD group was decreased more than the single EVD group (P<0.05) before and after IVF at 1, 3, 5, 7 days.However, the Graeb scores, ICP, GCS between the two groups showed no significant difference (P>0.05).The two groups during drainage were not found intracranial infection .Bilateral EVD group was significant better than single EVD group when comparing GOS score (t=12.63, P=0.000) and death rate (χ2 =7.57, P=0.006) in the six months .Conclusion Under the same conditions of IVF , the hematoma removal efficiency with bilateral EVD is higher than the single EVD in the serious , large volume of IVH patients and bilateral EVD can improve the prognosis and reduce death rate .At same time it does not increase intracranial infection rate and prolong the IVC placement time and ICU monitoring time .