脑室镜对脑室出血患者血肿清除率、并发症率及神经功能的改善作用

樊友道+尹海斌+张伟杰

[摘要] 目的 觀察脑室镜在脑室出血患者中的应用效果，分析脑室镜对患者血肿清除率、并发症发生率以及神经功能恢复的影响。 方法 选取2013年1月～2016年1月期间在我院诊断治疗的脑室出血患者85例作为研究对象，根据治疗方法的不同分为实验组和对照组，对照组患者行脑室穿刺外引流术，实验组患者在脑室镜下行脑室血肿清除术，观察并对比两组患者的血肿清除情况、并发症发生情况、治疗前后的神经功能MRS评分以及术后半年患者的日常生活能力ADL评分等，分析脑室镜对脑室出血患者的应用价值，旨在提高脑室出血的治疗效果。 结果 实验组患者术后48h清除患者脑血肿在90%以上的占35.6%，对照组患者术后48h清除患者脑血肿在90%以上的占7.5%，两组比较差异具有统计学意义（P<0.05）；实验组患者术后48h清除患者脑血肿在60%～90%之间的占60.0%，对照组患者术后48h清除患者脑血肿在在60%～90%之间的占27.5%，两组比较差异具有统计学意义（P<0.05）；实验组患者术后48h清除患者脑血肿小于60%的占4.4%，对照组患者术后48h清除患者脑血肿小于60%的占65.0%，两组比较差异具有统计学意义（P<0.05）。实验组患者术后并发症的发生率为6.6%，对照组患者术后并发症的发生率为30.0%，两组比较差异具有统计学意义（P<0.05）。两组治疗后的MRS评分差异具有统计学意义（P<0.05），两组患者治疗前后MRS组内评分比较差异均具有统计学意义（P<0.05）。实验组患者治疗后的日常生活能力ADL评分明显优于对照组患者，差异具有统计学意义（P<0.05）。 结论 脑室镜在脑室出血中应用效果显著，可提高脑血肿清除率，降低术后不良反应发生率，促进神经功能康复，具有一定的临床应用价值。

[关键词] 脑室镜；脑室出血；血肿清除；神经功能

[中图分类号] R651.1 [文献标识码] A [文章编号] 2095-0616（2017）08-206-04

[Abstract] Objective To observe the effect of ventriculoscope in application of patients with intraventricular hemorrhage and to analyze effect of ventriculoscope on hematoma clearance rate， complication rate and neurological function recovery. Methods 85 patients with intraventricular hemorrhage who were diagnosed and treated in our hospital from January 2013 to January 2016 were selected as research objects. They were divided into the experimental group and the control group according to different treatment methods. Patients in the control group were given ventricular puncture and drainage while patients in the experimental group were given intraventricular hematoma clearance with ventriculoscope. Hematoma clearance， complications， neurological function MRS scores before and after treatment， activity of daily living ADL score of postoperative half a year and other conditions of patients in two groups observed and compared. Therefore， value of ventriculoscope in application of patients with intraventricular hemorrhage was analyzed to improve curative effect of intraventricular hemorrhage. Results Hematoma clearance of postoperative 48h with a level of over 90% in the observation group accounted for 35.6% while that of the control group was 7.5%. Comparative difference between two groups was statistically significant （P<0.05）. Hematoma clearance of postoperative 48h with a level ranging from 60% to 90% in the observation group accounted for 60.0% while that of the control group was 27.5%. Comparative difference between two groups was statistically significant （P<0.05）. Hematoma clearance of postoperative 48h with a level of below 4.4% in the observation group accounted for 4.4% while that of the control group was 65%. Comparative difference between two groups was statistically significant （P<0.05）. Incidence of postoperative complications in the experimental group was 6.6% and that in the control group was 30%. The difference between two groups was statistically significant （P<0.05）. Differences of MRS score after treatment between two groups were statistically significant （P<0.05）. Differences in MRS scores in group before and after treatment of patients of two groups had statistical difference （P<0.05）. Activity of daily living ADL score after treatment of the experimental group was significantly better than that of the control group and the difference was statistically significant （P<0.05）. Conclusion Ventriculoscope in application of intraventricular hemorrhage has a significant effect. It can improve the clearance rate of cerebral hematoma， reduce the incidence of postoperative adverse reactions and promote the recovery of neurological function， which is of certain clinical application values.

[Key words] Intraventricular hemorrhage； Intraventricular hemorrhage； Hematoma clearance； Neurological function

颅内出血是神经外科的常见病和多发病，是高血压脑出血的一种，也是造成患者残疾和死亡的主要原因，预后效果极差，根据相关研究报道脑室出血被证实为影响预后的独立危险因素[1]。脑室出血的临床治疗需要快速清除脑室内的出血，传统的治疗方法是脑室外引流术，可以迅速降低患者的颅内压，持续引流脑室内积血，但会增加感染的风险，不利于患者神经功能的康复。目前治疗高血压脑出血手术方法有很多，包括显微镜下开颅手术、锁孔手术、通道穿刺术以及……