摘要：
Objective To investigate the efficacy of neuroendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage.Methods From August 2014 to August 2017,91 spontaneous thalamic hemorrhage ruptured into ventricles patients in Affiliated Hospital of the Yangzhou University were enrolled,who were underwent surgical treatment in this retrospective study.The patients were divided into the study group(n =41) and control group(n =50) based on different methods of treatment.The patients in the study group were given with remove visible intraventricular hematoma by neuroendoscopy,followed by External Ventricular Drainage (EVD) combined with urokinase fibrinolysis.The patients in control group were given with EVD combined with urokinase fibrinolysis.The time of postoperative drainage,ICU stay,duration of onset of fever,the number of intracranial infections,and the proportion of Glasgow outcome scale (GOS) (1 to 5) at 6 months postsurgery were compared between two groups.Measurement data were expressed as (Mean ± SD),and t test was used for measurement data.The count data were analyzed by x2 test or nonparametric rank sum test.Results The time of postoperative drainage,the number of intracranial infections,ICU stay in study group were (6.19 ± 1.1) d,5 cases,(2.8 ± 1.6) d,the indexes in control group were (7.06 ± 1.3) d,15 cases,(5.2 ± 2.0) d.The time of postoperative drainage,ICU stay,the number of intracranial infections were superior to those of the control group,and the difference was statistically significant.The proportion of GOS (1 to 5) at 6 months after surgery was 5 cases (12.2％),5 cases (12.2％),10 cases (24.4％),14 cases (34.1％),7 cases (17.1％) in study group,the indexes in control group were 10 cases(20.0％),13 cases (26.0％),11 cases(22.0％),10 cases(20.0％),6 cases(12.0％).The 6-month postoperative GOS of the study group were superior to those of the control group,and the difference was statistically significant (P ＜ 0.05).Conclusion Neruendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage can reduce the time of postoperative drainage and the incidence of intracranial infection,shorten the time of ICU stay and improve the functional prognosis of the patients.%目的 探讨神经内镜联合尿激酶在治疗自发性脑室出血铸型中的临床疗效.方法 采用回顾性分析方法,选择2014年8月-2017年8月在扬州大学附属医院收治的91例自发性丘脑出血破入脑室形成铸型患者的临床资料,根据不同的治疗方法将患者分为观察组(n=41)与对照组(n=50).观察组患者予以神经内镜清除可视的脑室内血肿,后再行脑室外引流(EVD)联合尿激酶纤溶治疗;对照组患者给予EVD联合尿激酶纤溶治疗.观察两组患者的术后引流管放置时间、颅内感染数量、滞留ICU时间、持续发热时间、术后6个月格拉斯哥预后评分(GOS)比例来评估疗效.计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验.计数资料组间比较采用x2检验或非参数秩和检验.结果 在两组共91例患者中,观察组患者的引流管置管时间、颅内感染数量、滞留ICU时间分别为(6.2±1.1)d、5例、(2.8±1.6)d,对照组分别为(7.1±1.3)d、15例、(5.2±2.0)d.观察组的引流管置管时间、颅内感染数量、滞留ICU时间优于对照组,差异有统计学意义(P＜0.05).观察组术后6个月GOS 1～5分的比例分别为5例(12.2％)、5例(12.2％)、10例(24.4％)、14例(34.1％)、7例(17.1％);对照组术后6个月GOS 1 ～5分的比例分别为10例(20.0％)、13例(26.0％)、11例(22.0％)、10例(20.0％)、6例(12％).观察组的术后6个月GOS优于对照组,差异有统计学意义(P＜0.05).结论 神经内镜联合尿激酶能减少患者外引流管放置时间,降低颅内感染发生率,缩短患者滞留ICU时间,并能提高患者功能预后.
