[1]张圣坤,唐忠,陈启富,等.长程、长时间持续脑室外引流术治疗脑室出血伴脑积水的临床疗效[J].中国临床神经外科杂志,2024,29(04):209-213.[doi:10.13798/j.issn.1009-153X.2024.04.004]
 ZHANG Sheng-kun,TANG Zhong,CHEN Qi-fu,et al.Clinical efficacy of long-tunneled and prolonged external ventricular drainage for patients with intraventricular hemorrhage associated with hydrocephalus[J].,2024,29(04):209-213.[doi:10.13798/j.issn.1009-153X.2024.04.004]
点击复制

长程、长时间持续脑室外引流术治疗脑室出血伴脑积水的临床疗效()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年04期
页码:
209-213
栏目:
论著
出版日期:
2024-04-30

文章信息/Info

Title:
Clinical efficacy of long-tunneled and prolonged external ventricular drainage for patients with intraventricular hemorrhage associated with hydrocephalus
文章编号:
1009-153X(2024)04-0209-05
作者:
张圣坤唐忠陈启富张铭芙陈思董白晶初明
518000广东,深圳市第三人民医院神经外科(张圣坤、唐忠、陈启富、张铭芙、陈思、董白晶、初明)
Author(s):
ZHANG Sheng-kun TANG Zhong CHEN Qi-fu ZHANG Ming-fu CHEN Si DONG Bai-jing CHU Ming
Department of Neurosurgery, Shenzhen Third People's Hospital, Shenzhen 518000, China
关键词:
脑室出血脑积水脑室外引流术疗效
Keywords:
Intraventricular hemorrhage Hydrocephalus External ventricular drainage Clinical efficacy
分类号:
R 743.34; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2024.04.004
文献标志码:
A
摘要:
目的 探讨长程、长时间脑室外引流术治疗脑室出血伴脑积水的临床疗效。方法 回顾性分析2019年10月至2022年12月应用脑室外引流术治疗的43例脑室出血伴脑积水的临床资料,其中26例采用传统脑室外引流术治疗(传统组),17例采用长程、长时间脑室外引流术治疗(长程长时间组)。结果 传统组引流管放置时间7~12 d,平均(9.76±1.14)d;长程长时间组引流管放置时间13~43 d,平均(16.17±5.29)d。长程长时间组住院时间[(18.70±6.99)d]较传统组[(15.53±3.16)d]有所增加,但两组无统计学差异(P=0.101)。长程长时间组二次脑室置管率(0%)、脑脊液漏发生率(0%)、颅内感染发生率(0%)较传统组(分别为30.77%、30.77%、26.92%)均明显降低(P<0.05)。术后3个月,长程长时间组预后良好率(100.00%;mRS评分0~2分)与传统组(96.15%)无统计学差异(P=0.605)。结论 长程、长时间脑室外引流术治疗脑室出血伴脑积水,虽然延长脑室引流管留置的时间,但是没有明显增加住院时间,而且明显降低二次脑室置管率、脑脊液漏和颅内感染发生率。
Abstract:
Objective To explore the clinical efficacy of long-tunneled and prolonged external ventricular drainage (EVD) for patients with intraventricular hemorrhage (IVH) associated with hydrocephalus. Methods A retrospective analysis was conducted on the clinical data of 43 patients with IVH associated with hydrocephalus who underwent EVD between October 2019 and December 2022. Among them, 26 patients were treated with traditional EVD (traditional group), and 17 patients received long-tunneled and prolonged EVD (long-tunneled and prolonged group). Results The mean duration of tube placement was significantly longer in the long-tunneled and prolonged group compared to the traditional group (16.17±5.29 days vs. 9.76±1.14 days). Although the average hospital stay was slightly prolonged in the long-tunneled and prolonged group (18.70±6.99 days vs. 15.53±3.16 days), there was no statistically significant difference between both groups (P=0.101). Notably, the rates of secondary ventricular catheter placement (0% vs. 30.77%), cerebrospinal fluid leakage (0% vs. 30.77%%), and intracranial infection (0% vs. 26.92%) were markedly lower in the long-tunneled and prolonged group compared to the traditional group (P<0.05). At three months post-EVD, the good prognosis rate (100%; mRS score of 0~2) in the long-tunneled and prolonged group did not significantly differ from the traditional group (96.15%; P=0.605). Conclusions Long-tunneled and prolonged EVD is effective for patients with IVH accompanied by hydrocephalus; although it prolongs EVD tube placement duration, it dose not significantly increase hospital stay. It also reduces secondary ventricular catheter placement rate as well as rates of cerebrospinal fluid leakage and intracranial infection.

参考文献/References:

[1]ZHOU CY, ZHU RL, JIANG XX, et al. Comparison of curative effect on intraventricular hemo-rrhage: neuroendoscopic surgery combined with extra-ventricular drainage vresus simple extraventricular drainage [J]. Chin J Clin Neurosurg, 2021, 26(2): 77-78. 周朝阳,朱荣岚,姜星星,等. 神经内镜手术联合脑室外引流术与单纯脑室外引流术治疗脑室出血的疗效比较[J]. 中国临床神经外科杂志,2021,26(2):77-78.  [2]CRAEN A, MANGAL R, STEAD TG, et al. Gender differences in outcomes after non-traumatic intracerebral hemorrhage [J]. Cureus, 2019, 11(10): e5818.
[3]ZIAI WC, TUHRIM S, LANE K, et al. A multicenter, randomized, double-blinded, placebo-controlled phase III study of Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR III) [J]. Int J Stroke, 2014, 9(4): 536-542.
[4]WITSCH J, BRUCE E, MEYERS E, et al. Intraventricular hemorrhage expansion in patients with spontaneous intracerebral hemorrhage [J]. Neurology, 2015, 84(10): 989-994.
[5]HANSEN BM, MORGAN TC, BETZ JF, et al. Intraventricular extension of supratentorial intracerebral hemorrhage: the modified Graeb scale improves outcome prediction in Lund Stroke Register [J]. Neuroepidemiology, 2016, 46(1): 43-50.
[6]KRISHNAMURTHI RV, FEIGIN VL, FOROUZANFAR MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010 [J]. Lancet Glob Health, 2013, 1(5): e259-e281.
[7]WAGNER KR, XI G, HUA Y, et al. Ultra-early clot aspiration after lysis with tissue plasminogen activator in a porcine model of intracerebral hemorrhage: edema reduction and blood-brain barrier protection [J]. J Neurosurg, 1999, 90(3): 491-498.
[8]JAMJOOM AAB, JOANNIDES AJ, POON MT, et al. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland [J]. J Neurol Neurosurg Psychiatry, 2018, 89 (2): 120-126.
[9]RAMANAN M, LIPMAN J, SHORR A, et al. A meta-analysis of ventriculostomy-associated cerebrospinal fluid infections [J]. BMC Infect Dis, 2015, 15: 3.
[10]COLLINS CD, HARTLEY JC, CHAKRABORTY A, et al. Long subcutaneous tunnelling reduces infection rates in paediatric external ventricular drains [J]. Childs Nerv Syst, 2014, 30(10): 1671-1678.
[11]MIKHAYLOV Y, WILSON TJ, RAJAJEE V, et al. Efficacy of antibiotic-impregnated external ventricular drains in reducing ventriculostomy-associated infections [J]. J Clin Neurosci, 2014, 21(5): 765-768.
[12]KONSTANTELIAS AA, VARDAKAS KZ, POLYZOS KA, et al. Antimicrobial-impregnated and -coated shunt catheters for prevention of infections in patients with hydrocephalus: a systematic review and meta-analysis [J]. J Neurosurg, 2015, 122(5): 1096-1112.
[13]PARK J, CHOI YJ, OHK B, et al. Cerebrospinal fluid leak at percutaneous exit of ventricular catheter as a crucial risk factor for external ventricular drainage-related infection in adult neurosurgical patients [J]. World Neurosurg, 2018, 109: e398-e403.
[14]HE C, YANG G, ZHAO M, et al. A clinical study of high-dose urokinase for the treatment of the patients with hypertension induced ventricular hemorrhage [J]. Prog Brain Res, 2021, 266: 349-355.

相似文献/References:

[1]周 平 邓 燕 王 辉 罗 杰 胡钧涛 刘开军 李安荣 李新建.脊髓脊膜膨出合并脑积水分流手术时机的选择[J].中国临床神经外科杂志,2015,(11):692.[doi:10.13798/j.issn.1009-153X.2015.11.017]
[2]王光明 成 毅 胡克亮.经侧脑室三角区入路手术治疗重型自发性脑室出血[J].中国临床神经外科杂志,2016,(05):306.[doi:10.13798/j.issn.1009-153X.2016.05.018]
[3]李光亮 赵向南 王方艺.创伤性蛛网膜下腔出血继发脑积水的临床分析[J].中国临床神经外科杂志,2016,(07):433.[doi:10.13798/j.issn.1009-153X.2016.07.015]
[4]符传艺 陈健龙 张 茂 刘朝晖 黄垂学 黄 军 马建荣 赵建农.表现为脑室出血的颅内破裂动脉瘤的诊治[J].中国临床神经外科杂志,2016,(04):234.[doi:10.13798/j.issn.1009-153X.2016.04.014]
[5]娄元华 李小勇 陈红伟 潘栋超 解东成 刘东升.婴儿脑积水分流术后硬膜下积液的临床分析[J].中国临床神经外科杂志,2016,(04):245.[doi:10.13798/j.issn.1009-153X.2016.04.019]
[6]张家康 彭 飞 陈 鑫 侯 旭 张大明 刘震东 赵世光.后颅窝减压术治疗Chiari畸形Ⅰ型合并脑积水疗效的Meta分析[J].中国临床神经外科杂志,2016,(03):158.[doi:10.13798/j.issn.1009-153X.2016.03.009]
 ZHANG Jia-kang,PENG Fei,CHEN Xin,et al.Posterion fossa decompression for Chiari I malformation with hydrocephalus: a meta-analysis[J].,2016,(04):158.[doi:10.13798/j.issn.1009-153X.2016.03.009]
[7]云德波 张 逵 范润金 唐 辉 谯 飞 陈华轩.脑室-腹腔分流术后分流不畅的原因分析及处理[J].中国临床神经外科杂志,2016,(02):92.[doi:10.13798/j.issn.1009-153X.2016.02.011]
 YUN De-bo,ZHANG Kui,FAN Run-Jin,et al.Analysis of cause and countermeasures of poor diversion after ventriculoperitoneal shunt in patients with hydrocephalus[J].,2016,(04):92.[doi:10.13798/j.issn.1009-153X.2016.02.011]
[8]张建民.颅骨缺损合并脑积水及脑软化灶形成的手术治疗(附40例报告)[J].中国临床神经外科杂志,2016,(01):51.[doi:10.13798/j.issn.1009-153X.2016.01.019]
[9]申汉威 李俊卿 李红星 汪立刚 杨孔宾.颅内破裂动脉瘤夹闭术与血管内栓塞术后脑积水发生率的比较分析[J].中国临床神经外科杂志,2015,(03):140.[doi:10.13798/j.issn.1009-153X.2015.03.004]
 SHEN Han-wei,LI Jun-qing,LI Hong-xing,et al.Clinical study and Meta-analysis of incidences of hydrocephalus after microsurgery and endovascular embolization in patients with ruptured intracranial aneurysms[J].,2015,(04):140.[doi:10.13798/j.issn.1009-153X.2015.03.004]
[10]于 峰 王 路 门学忠 朱 冰 孙希炎.重度脑积水脑室-腹腔分流术后继发硬膜下血肿2例[J].中国临床神经外科杂志,2015,(03):192.[doi:10.13798/j.issn.1009-153X.2015.03.025]
[11]刁 勋 董 策 朱 琳 潘宝根 野战鹰 张晓阳 王 琮 默 峰.神经内镜在丘脑出血破入脑室手术中的应用[J].中国临床神经外科杂志,2019,(09):516.[doi:10.13798/j.issn.1009-153X.2019.09.002]
 DIAO Xun,DONG Ce,ZHU Lin,et al.Neuroendoscopic surgery for thalamic hemorrhage broken into ventricle[J].,2019,(04):516.[doi:10.13798/j.issn.1009-153X.2019.09.002]
[12]晁晓峰 战文建 谢满意 苗发安 梁 君 于如同.脑积水脑室-腹腔分流术后脑室内出血7例处理分析[J].中国临床神经外科杂志,2020,(09):620.[doi:10.13798/j.issn.1009-153X.2020.09.014]

备注/Memo

备注/Memo:
(2022-12-29收稿,2024-01-18修回) 基金项目:深圳大学高水平临床专项-深圳市神经外科专科培训试点基地提升项目(LCXKB202415);深圳市高水平医院建设专项 通信作者:初 明,Email:chuming120@163.com
更新日期/Last Update: 2024-04-30