摘要
目的探讨颅内动脉瘤破裂合并脑室出血铸型的治疗策略。方法 78例颅内动脉瘤破裂合并脑室出血铸型患者分为传统治疗组(对照组)38例和综合治疗组(观察组)40例。对照组入院后立即实施脑血管造影并使用弹簧圈栓塞动脉瘤,介入术后行脑室穿刺引流术,术后每日经引流管注入尿激酶促进引流血块。观察组入院后在脑血管介入治疗前先进行侧脑室穿刺术,暂不引流脑脊液,在动脉瘤栓塞成功后立即开始引流血性脑脊液,术后规律注入尿激酶,并持续监测颅内压,辅以亚低温等综合治疗措施。随访6个月,根据格拉斯哥预后评分系统评价并对比2组的疗效。结果对照组轻残6例,中残9例,重残12例,植物生存5例,死亡6例,恢复良好率为15.79%;观察组轻残15例,中残10例,重残6例,植物生存5例,死亡4例,恢复良好率为37.50%,与对照组相比其恢复良好率差异有统计学意义(P<0.05)。结论早期介入栓塞动脉瘤并行脑室引流术,尽早引流脑室内血块,再辅以亚低温等综合治疗,是治疗颅内动脉瘤破裂伴脑室出血铸型的有效方法。
Objective To study the therapy of intracranial aneurysm rupture combined with intraventricular hemorrhage cast. Methods Seventy-eight patients with intracranial aneurysm rupture and intraventricular hemorrhage cast were divided into conventional treatment therapy（ control group, n = 38 ） and combined therapy group （ observation group, n = 40）. The pa- tients in control group were performed with digital subtraction arteriography（DSA） and coil embolization of aneurysm, and were treated with ventricular puncture drainage after the interventional therapy. The urokinase was injected into the ventricle through the catheter every day so as to promote the elimination of the hematoma. The patients in observation group were performed with ventriculocentesis before DSA, but without drainage of cerebrospinal fluid. After the interventional therapy, the patients were treated with ventricular cerebral spinal fluid drainage at once, and the urokinase was regularly injected through the catheter and the intracranial pressure was monitored continuously. The mild hypothermia therapy and other combined therapeutic measures was performed in the next days. All patients were followed up for 6 months ,the curative effect was evaluated and compared be- tween the two groups according to Glasgow outcome scale. Results Among the patients in control group, mild disability in 6 cases, moderate disability in 9 cases, severe disability in 12 cases, vegetative state in 5 cases, and 6 cases were dead, the good recover rate was 15.79%. Among the patients in observation group, mild disability in 15 cases, moderate disability in 10 cases, severe disability in 6 cases, vegetative state in 5 cases, and 4 cases were dead, the good recover rate was 37.50%. There was statistically significant difference in the good recover rate between the two groups （ P 〈 0.05 ）. Conclusion Early endovascular treatment of aneurysm embolization cooperated with ventricle puncture drainage and mild hypothermia therapy is the effective method of treating ruptured aneurysm combined intraventricular hemorrhage cast.
出处
《新乡医学院学报》
CAS
2012年第11期853-855,共3页
Journal of Xinxiang Medical University
关键词
颅内动脉瘤
脑室出血铸型
介入栓塞
脑室引流
亚低温治疗
intracranial aneurysm
ventricular hemorrhage cast
interventional aneurysm embolization
ventricular drain- age
mild hypothermia therapy
