脑室穿刺治疗高血压丘脑出血破入脑室的观察

摘要

Objective:To investigate the technique and effect of ventricle puncture ( including double paraceles, single paracele and diacele puncture ) in the treatment of patients with hypertensive thalamic hemorrhage that ruptured into ventricles.Methods:30 patients with hypertensive thalamic hemorrhage that ruptured into ventricles, were punctured in double paraceles or single paracele and diacele with soft drainage tubes, depended on their CT image data, and then, were injected urokinase into paracele or diacele by the tubes after oprations.Results:Paraceles puncture success rate was 97.67%, diacele puncture success rate was 76.47%in the 30 cases.Hematomas in Ventricles were evacuated almost completely,the time of the ventricular system recovery was 1~4 days,and the drainage tubes were removed 3~7 days later.Conclusion:For patiets with hypertensive thalamic hemorrhage that ruptured into ventricles, the application of ventricles puncture can help to reduce the intracranial pressure quickly,make the disease remission;injecting urokinase into ventricles for dissolving the hematoma help to increase ventricular system recovery speed and reduce the mechanical and chemical destructiveness from the hematoma,improve the prognosis.The opration is simple, effective, with fewer complications in the emergency treatment of hypertensive thalamic hemorrhage that ruptured into ventricles.%目的：探讨用简单的脑室穿刺外引流方法治疗高血压丘脑出血破入脑室患者的临床技巧及疗效。方法：对30例高血压丘脑出血并破入脑室患者，根据头颅CT影像资料，采用软质硅胶引流管穿刺侧脑室前角和（或）三脑室，术中抽吸部分血肿，术后经引流管注入尿激酶溶解脑室内血肿。结果：侧脑室穿刺成功率为97.67％，三脑室穿刺成功率76.47％；血肿完全消失、脑室系统恢复通.的时间为1～4 d。结论：对高血压丘脑出血破入脑室的患者，应用侧脑室穿刺外引流术，特别是结合三脑室穿刺，可快速降低颅内压，缓解病情，术后辅以尿激酶溶解室间孔、三脑室、四脑室内血肿，可较快促使脑脊液循环复通，减轻血肿对丘脑、下丘脑的机械性及化学性破坏，改善预后，是简单、有效、并发症少的抢救性治疗手段。