【作者】 张伟；

【导师】 李新钢；

【作者基本信息】 山东大学 ， 神经外科（专业学位）， 2015， 博士

【摘要】 研究背景与目的高血压幕上脑出血是临床最常见的原发性脑出血类型,手术已成为非常重要的治疗方法。常见的手术方式包括开颅血肿清除去骨瓣减压术、小骨窗开颅血肿清除术、钻孔引流术、立体定向血肿排空术、神经内镜下血肿清除术等。而对于手术必要性、手术方式、手术时机等的选择仍是临床中争论较多的问题。近年来,随着神经内镜技术及相关配套器材的发展,神经内镜下血肿清除术被越来越多的神经外科医师所认可,但临床上对于神经内镜手术适应症及神经内镜手术的有效性仍存在争议。本研究通过对高血压幕上脑出血手术治疗患者临床资料分析总结,并与同期保守治疗患者进行对比研究,比较手术与保守治疗、不同手术方式、不同手术时间等对于患者预后的影响,为临床治疗高血压幕上脑出血提供更多参考。方法根据制定的纳入标准,回顾性总结2012年6月至2014年6月收治的223例高血压幕上脑出血患者资料进行分析。其中手术治疗136例,手术方式分为神经内镜下血肿清除术与开颅血肿清除术。神经内镜血肿清除术65例,开颅血肿清除术71例。根据血肿量大小分为少量出血组(<40m1)和大量出血组(≥40m1),其中少量出血组45例,大量出血组91例。而对照保守治疗组包括87例患者,其中少量出血组36例,大量出血组51例。各组间性别、年龄、血肿量、术前GCS评分等基线资料一致。评估标准包括手术前后的GCS评分、血肿清除率、再出血率、血肿完全吸收时间、住院时间、手术时间、术后6月日常生活能力(ADL)评分等,将ADL评分Ⅰ-Ⅲ级患者设定为预后良好,Ⅳ-V级患者设定为预后不良。评价保守治疗与手术治疗疗效差别,内镜手术与开颅手术疗效差别。78例在发病后6小时内手术(超早期手术),58例在发病后7-72小时手术(早期手术),比较不同手术时间术后死亡率、发生其它并发症率、日常生活能力情况等,以评价不同手术时机对预后影响。结果1.保守治疗与手术治疗比较保守治疗组血肿平均吸收时间29.2±5.4天,平均住院时间28.4±7.1天,再出血21例(24.1%),出现其它并发症21例(24.1%),死亡11例(12.6%),治疗后6月日常生活能力评定(Ⅰ-Ⅲ级)64例(73.6%),Ⅳ-Ⅴ级23例(26.4%)。血肿清除手术组血肿平均吸收时间4.7±1.4天,平均住院时间19.1±3.2天,再出血10例(7.3%),出现其它并发症12例(8.8%),死亡7例(5.1%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)122例(89.7%),Ⅳ-Ⅴ级14例(10.3%)。两组比较,各统计量差异均具有统计学意义,P<0.05。2.内镜手术组与开颅手术组比较内镜手术组平均血肿清除率89.7±4.7%,平均手术时间103.6±32.1分钟,术中出血平均110.7±43.1ml,平均住院时间17.2±4.1天,术后再出血4例(6.2%),死亡3例(4.6%),术后GCS评分提高2分以上者51例(78.4%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)59例(90.8%),Ⅳ-Ⅴ级6例(9.2%)。开颅手术组平均血肿清除率87.8±6.7%,平均手术时间190.1±41分钟,术中出血平均480.2±81.1m1,平均住院时间21.1±3.4天,术后再出血6例(8.4%),死亡4例(5.6%),术后GCS评分提高2分以上者60例(84.5%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)63例(88.7%),Ⅳ-Ⅴ级8例(11.3%)。两组比较,手术用时、术中出血及住院时间具有统计学差异,P<0.001；血肿清除率、治疗后GCS变化、术后再出血率、死亡率、预后良好率差异均无统计学意义,P>0.05。3.手术时期对预后的影响超早期手术组术后死亡1例(1.3%),术后发生其它并发症者8例(10.3%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)72例(92.3%),Ⅳ-Ⅴ级6例(7.7%)。早期手术组术后死亡6例(10.3%),术后发生其它并发症者14例(24.1%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)50例(86.2%),Ⅳ-Ⅴ级8例(13.8%)。两组比较,死亡率及并发症发生率P<0.05,差异具有统计学意义,而超早期手术预后良好率优于早期手术,但P>0.05,差异无统计学意义。4.不同血肿量与手术关系比较血肿量<40m1者,内镜手术组22例,术后死亡0例,术后6月日常生活能力评定(Ⅰ-Ⅲ级)22例(100%),Ⅳ-Ⅴ级0例；开颅手术组23例,术后死亡0例,术后6月日常生活能力评定(Ⅰ-Ⅲ级)23例(100%),Ⅳ-Ⅴ级0例。血肿量≥40m1者,内镜手术组43例,术后死亡3例(7.0%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)35例(81.4%),Ⅳ-Ⅴ级8例(18.6%)；开颅手术组48例,术后死亡4例(8.3%),术后6月日常生活能力评定(Ⅰ-Ⅲ级)37例(77.1%),Ⅳ-Ⅴ级11例(22.9%)。两组比较,血肿少于40m1组,内镜组与开颅组死亡率及预后良好率相等；血肿大于等于40m1者,内镜组较开颅组死亡率低,而预后良好率更高,但P>0.05,差异无统计学意义。结论1.高血压幕上脑出血患者在死亡率、病残率、血肿吸收时间、住院时间、出现其它并发症等方面,手术治疗均优于保守治疗。2.神经内镜血肿清除术较开颅手术可缩短手术时间及住院时间、减少术中出血量,差别具有统计学意义。虽有更高的血肿清除率,但差别尚无统计学意义。3.超早期手术(<6小时)与早期手术(6-72小时)相比,死亡率、并发症发生率更低,差别具有统计学意义,预后良好率无明显差异。4.血肿量<40m1者内镜手术与开颅手术均有较好疗效；血肿量≥40m1者内镜组手术总体死亡率、预后良好率(ADL评分Ⅰ-Ⅲ级)、病残率(ADL评分Ⅳ-Ⅴ级)优于手术组,但差别无统计学意义。研究背景和目的脑室出血是临床中较为常见的神经科危急重症,病情进展较快,病死率较高,预后不佳。脑室外引流术是治疗脑室出血的主要方法,其有效性已经被广泛认可。快速细孔钻颅脑室外引流术利用张庆林、张成教授发明的快速细孔钻颅器自1977年成功抢救一名脑疝晚期的脑室出血患者后在全省甚至全国被广泛应用。但对于快速细孔钻颅脑室外引流术治疗脑室出血,尚缺乏相关影响因素系统、全面的研究。本课题通过对快速细孔钻颅侧脑室外引流治疗重型及特重型脑室出血的病例资料进行回顾性研究,分析影响其预后的相关因素,为此技术的临床应用提供更多参考。资料和方法本研究收集自2006年1月至2013年12月期间收治的GCS评分≤9分的重型、特重型脑室出血患者共396例临床资料进行分析,所有患者均施行快速细孔钻颅脑室外引流术。随访术后第3个月GOS评分作为预后评价,1-2分预后差,3-5分为预后好。分析不同影响因素与预后关系。结果1.一般情况男性238例,女性158例,男：女=1.5：1；年龄≤40岁79例,40岁-60岁198例,≥60岁119例；术前GCS评分3-5分179例,6-9分217例；发病至手术时间≤6小时272例,>6小时124例；术后24小时内再出血87例；留置管时间≥10天211例,<10天185例,平均留置管时间12.4±6.7天；单侧引流206例,双侧引流190例；联合尿激酶治疗301例,单纯引流治疗95例；发生颅内感染18例,感染率4.5%；治疗中发生引流管堵塞71例,其中发生颅内感染7例,感染率9.9%。术后随访3个月,死亡(GOS1分)95例,植物生存(GOS2分)114例,完全恢复(GOS5分)107例,不完全恢复(GOS3-4分)80例。将GOS评分1-2分设为预后不良,3-5分设为预后良好。2.不同影响因素与预后关系2.1年龄≤40岁79例,死亡16例,死亡率20.3%,预后良好39例,预后良好率49.4%；年龄40岁-60岁198例,死亡52例,死亡率26.3%,预后良好97例,预后良好率48.9%；年龄≥60岁119例,死亡27例,死亡率22.7%,预后良好51例,预后良好率42.9%。经卡方检验,不同年龄死亡率及预后良好率差别无统计学意义,说明年龄不是决定重型及特重型脑室出血患者预后的关键因素。2.2 GCS评分3-5 179例,死亡51例,死亡率28.5%,预后良好89例,预后良好率49.7%；GCS评分6-9分者217例,死亡44例,死亡率20.2%,预后良好98例,预后良好率45.2%。两组死亡率及预后良好率比较,P>0.05,差异不具有统计学意义,说明GCS评分不是决定重型及特重型脑室出血患者预后的关键因素。2.3发病6小时以内手术272例,死亡36例,死亡率13.2%,预后良好151例,预后良好率55.5%；发病至手术时间超过6小时124例,死亡59例,死亡率47.6%,预后良好36例,预后良好率29.0%。两组比较死亡率及预后良好率均具有统计学意义。2.4术后24小时内再出血87例,死亡31例,死亡率35.6%,预后良好22例,预后良好率25.2%；术后24小时内未再出血309例,死亡64例,死亡率20.7%,预后良好165例,预后良好率53.4%。两组比较死亡率及预后良好率差别均有统计学意义。2.5单双侧引流对留置管时间及血肿吸收时间影响双侧引流者平均留置管时间8.2±3.2天,脑室内血肿完全吸收时间平均7.1±2.7天；单侧引流者平均置管14.3±5.7天,脑室内血肿完全吸收时间平均11.4±3.2天。两者比较,P<0.05,说明双侧引流较单侧引流可更快的清除血肿,具有较短的留置管时间。2.6联合尿激酶应用301例,死亡59例,死亡率19.6%,预后良好149例,预后良好率49.5%；未用尿激酶者95例,死亡36例,死亡率37.8%,预后良好38例,预后良好率40%。两组比较死亡率差别有统计学意义,而预后良好率差别无统计学意义,说明早期联合应用尿激酶可降低重症脑室出血患者死亡率,但对改善总体预后意义不大。2.7联合应用尿激酶者平均留置管时间7.9±3.2天,血肿平均吸收时间5.2±3.7天；未应用尿激酶者平均留置管时间15.2±6.1天,血肿平均吸收时间11.2±4.2天。两者留置管时间及血肿吸收时间分别经t检验,P<0.05,具有统计学意义。2.8发生颅内感染者共18例,死亡3例,死亡率16.7%,预后良好4例,预后良好率22.2%；未发生颅内感染者378例,死亡15例,死亡率3.9%,预后良好182例,预后良好率48.1%。两组比较死亡率及预后良好率均具有统计学意义。3.颅内感染发生的影响因素及细菌培养结果3.1不同留置管时间与颅内感染关系将引流管留置时间分为≤7天、8-14天、15-20天及≥21天进行分组统计不同留置管时间颅内感染发生率。结果发现≤7天组及≥21天组颅内感染发生率较中间两组高,但四组比较P>0.05,差异无统计学意义。3.2引流管堵塞与颅内感染关系治疗中发生引流管堵塞需重新置管71例,其中发生颅内感染7例,感染率9.9%；引流管未发生堵塞325例,发生颅内感染11例,感染率3.4%,两者比较P<0.05差异具有统计学意义,说明堵管可增加颅内感染的发生。3.3.颅内感染培养结果本组病例共发生颅内感染18例,总体感染率4.5%。其中细菌培养阳性11例,表皮葡萄球菌4例,金黄色葡萄球菌2例,溶血葡萄球菌1例,大肠埃希菌2例,肺炎克雷伯杆菌1例,嗜麦芽窄食单胞菌1例。结论1.快速细孔钻颅侧脑室外引流术用时短,操作简便,可在发病后快速施行,是挽救危重脑室出血患者生命的有效手段。2.不同年龄患者死亡率及治疗预后良好率无明显差别,年龄对特重型脑室出血患者预后无显著影响。3.经过积极救治,术前GCS评分较低的特重型脑室出血患者也可获得相对较好的预后。4.发病后尽早(6小时以内)行侧脑室外引流术可降低死亡率,改善预后。5.术后24小时内发生再出血可增加死亡率,影响患者预后。6.双侧脑室外引流较单侧脑室外引流血肿清除更快,留置管时间更短。7.应用尿激酶脑室内注入可加速血肿吸收,缩短留置管时间,降低死亡率,但对总体预后改善不明显。8.治疗中发生引流管堵塞可增加颅内感染发生率,而颅内感染可增加死亡率,影响患者预后。颅内感染致病菌以葡萄球菌多见,且多为耐药菌。更多还原

【Abstract】 Background and objectivesHypertensive supratentorial intracerebral hemorrhage is the most common type of primary intracerebral hemorrhage and surgical treatment has become one of the most important methods, which includes bone flap craniotomy and decompression, small bone window craniotomy hematoma evacuation, burr hole drilling and drainage, stereotactic hematoma evacuation, neuro-endoscopic hematoma evacuation, etc. While the necessity for surgery, choice of surgical methods and time is still of the questions at issue. In recent years, with the development of endoscopic technology and related equipments, endoscopic hematoma evacuation is recognized by more and more neurosurgeons, but the indications and clinical effectiveness of neuroendoscopic surgery is still controversial. So, the clinical materials, such as conservative treatment and surgical treatment, different surgical methods, different surgical time, prognosis and so on, were analized and compared with those of patients who were given conservative treatment during the same period. Make sense, better strategies could be provided for clinical treatment of hypertensive intracerebral hemorrhage.Methods223 cases of hypertensive supratentorial cerebral hemorrhage patients under our criteria were admitted in our department from June 2012 to June 2014.136 cases were performed surgical methods including neuro-endoscopic craniotomy and craniectomy hematoma evacuation, which contained 65 cases and 71 cases respectively. According to the volume of hematoma, they were divided into small hemorrhage Group (<40ml) and massive hemorrhage Group(≥40ml), which contained 45 cases and 91 cases respectively.87 cases were performed conservative treatment, which contained 36 cases of small hemorrhag(<40ml)e and 51 cases of massive hemorrhage (≥40ml). Evaluation criterions include preoperative GCS score, hematoma clearance, rehaemorrhagia, complete hematoma absorption time, length of stay, time of operation, activity of daily living (ADL)assessment etc, ADL of grade Ⅰ-Ⅲ means effective,while grade Ⅳ-Ⅴ means failure.The difference of curative effect between conservative and operative treatment, endoscopic surgery and routine craniotomy operation were evaluated.78 cases were performed operation within 6 hours after the onset (super-early operation group), while the other 58 cases 7-72 hours after the onset (early operation group). In order to evaluate the effect of prognosis of different operation methods, postoperative mortality, complication rates, activity of daily living were compared.Results1.Comparison between conservative treatment group and surgical methods group.Mean hematoma absorption time of conservative treatment group was 29.2±5.4 days, average length of stay was 28.4±7.1 days,21 cases occurred rebleeding (24.1%),21 cases occurred other complications,11 cases died (12.6%). The assessment of activity of daily living (ADL)in Ⅰ-Ⅲ level and Ⅳ-Ⅴ level contained 64 cases (73.6%) and 23 cases (26.4%) respectively. Mean hematoma absorption time of the surgery group was 4.7±1.4 days, average length of stay was 19.1±3.2 days,10 cases occurred rebleeding (7.3%),12 cases occurred other complications (8.8%),7 cases died (5.1%). The assessment of activity of daily living (ADL) in I-III level and Ⅳ-Ⅴ level contained 122 cases (89.7%) and 14 cases (10.3%) respectively.2. Comparison between endoscopic surgery group and craniectomy surgery groupFor endoscopic surgery group, the average hematoma cleared rate was 89.7±4.7%, average operation time was 123.6±32.1minutes, average blood loss was 110±43.1 ml, average time of stay was 17.2±4.1 days,4 cases occurred rebleeding (6.2%),2 cases died (3.1%),51 cases’(78.4%)postoperation GCS scores improved more than 2 points. The assessment of activity of daily living (ADL)in I-III level and IV-V level contained 59 cases (90.8%) and 6 cases (9.2%. Average hematoma clearance rate in craniectomy surgery group was 87.8±6.7%, average surgery time was 190.1±41 minutes, average blood loss was 480±81.1 ml, average time of stay was 21.1±3.4 days,6 cases occurred rebleeding(8.4%),3 cases died(4.2%),60(84.5%) cases ’postoperation GCS scores improved more than 2 points. The assessment of activity of daily living (ADL) in I-III level and Ⅳ-Ⅴ level contained 63 cases (88.7%) and 8 cases (11.3%) respectively.Postoperative complications of the endoscopic operation:1 cases of pulmonary infection,5 cases of urinary tract infection,4 cases of rebleeding,3 cases died. The first case died of rebleeding,6 hours after the endoscopic operation, who was performed craniectomy again; the second case died of MODS caused by pulmonary infection of multidrug resistant Pseudomonas aeruginosa and baumanii, which finally develop into fungemia, one died for acute kidney failure.Postoperative complication of craniectomy group:10 cases of pulmonary infection, 6 cases of rebleeding,4 cases died. One died for postoperative rebleeding and secondary MODS, two for pulmonary infection, one died of pulmonary embolism.3. Comparison of groups with different surgical opportunity.Super-early surgery group had 1 case(1.3%) died, and 8 cases(10.3%) with complications after operation. The assessment of activity of daily living (ADL) in I-III level and Ⅳ-Ⅴ -level contained 72 cases(92.3%) and 6 cases(7.7%) respectively.Early surgery group had 6 cases(10.3%) of died, and 14 cases(24.1%) with complications after operation. The assessment of activity of daily living (ADL) in I-III level and Ⅳ-Ⅴ level contained 50 cases (86.2%) and 8 cases (13.8%) respectively.4. Comparison of surgery groups with differernt amount of hematoma.In terms of hematoma volume<40 ml, there is no death in the endoscopic surgery group which include 22 cases, the assessment of activity of daily living (ADL) in (Ⅰ-Ⅲ level)and(Ⅳ-Ⅴ level) contained 24 cases (100%) and 0 cases respectively; there are no deaths in craniectomy surgery group which include 23 case. The assessment of activity of daily living (ADL) in Ⅰ-Ⅲ level and Ⅳ-Ⅴ level contained 23cases (100%) and 0 cases respectively.In terms of hematoma volume≥40 ml, there are 3 deathes in the endoscopic surgery group which include 43 cases. The assessment of activity of daily living (ADL) in Ⅰ-Ⅲ level and Ⅳ-Ⅴ level contained 35 cases (81.4%) and 8 cases(18.6%)respectively; there are 4 deaths in craniectomy surgery group which include 48 cases, The assessment of activity of daily living (ADL) in Ⅰ-Ⅲ level and Ⅳ-Ⅴ level contained 37 cases (77.1%) and 11 cases (22.9%)respectively.Conclusions1. Cases with hypertensive cerebral hemorrhage performed craniotomy surgery have a lower rate on mortality, invalidity, hematoma absorption time, time of stay and complication rate compared with conservative treatment.2. Endoscopic surgery may shorten the operation time, time of stay and blood loss, the differences had statistical significance.Though endoscopic surgery with higher hematoma clearance rate, the difference had no statistical significance.3. Super-early operation(<6 hours) had lower mortality and complication rates than early operation (6-72 hours), while there’s no sigificant rate of good outcome.4. In terms of hematoma volume<40 ml, endoscopic surgery group and craniectomy group had no differences in mortality rate and morbidity rate (ADL assessment Ⅳ-Ⅴ level); when hematoma volume≥40 ml, endoscopic surgery group had higher efficiency than craniectomy group, while there’s no statistical significance.Background and objectivesIntraventricular hemorrhage (IVH) was one of the most common emergency dieases of neurosurgery, which develops quickly with high mortality rate and poor prognosis. External ventricular drainage (EVD) was one of the most important means of treatment of This diease and its validity has been widely recognized. The machine, invented by professor Zhang Qinglin and Zhang Cheng, was widely used since a patient suffering late cerebral hernia was successfully rescued in 1977. But systematic and comprehensive study of influential factors of rapid pore cranial drilling was still not sufficient. This study was to provide more references for the use of this technique by carrying retrospective study of it’s use in the treatment of severe intraventricular hemorrhage, related factors affecting the prognosis.Materials and methodsThis study lasted from January 2006 to December 2013, collecting 396 cases from four hospitals. All the cases were severe or extremely severe types of intraventricular hemorrhage with GCS score≤9 points. GOS score of the 3rd month after the operation was evaluated as prognostic outcome,1-2 points defined poor while 3-5 points fine. Differences of prognosis effects with different factors was analized.Results1. General conditionsAge≤40y group contained 79 cases,40-60y group contained 198 cases, age≥60y group contained 119 cases; 272 cases belong to the group who were given rapid pore cranial drilling within 6 hours from the onset, while 124 cases over 6 hours; preoperative GCS score marked between 3 to 5 points included 179 cases, while 6 to 9 points 217 cases; 87 cases occurred rebleeding within 24 hours; 18 cases occurred intracranial infection, with a infection rate of 4.5%; 211 cases had their tube remained more than 10 days, while only 185 cases less than 10 days, while the average time was 12.4±6.7 days; 206 cases treated with bilateral drainage, while 190 cases with unilateral drainage; 301 cases used urokinase, while 95 cases with simply drainage for treatment; 71 cases’tube blocked during the treatment,7 cases infected(9.9%).All the cases were followed up for 3 months at least.95 cases died (GOS 1point), 114 cases were being plant survival (GOS 2 points),107 cases were full restoration (GOS 5 points),80 cases had incomplete recovery (GOS 3-4 points). GOS 1-2 points considered as unfavourable prognosis; GOS 3-5 points considered as favourable prognosis.2. The influence of different factors on the prognosis2.1 The age of 79 cases was less than 40 years old,16 cases of them died, mortality rate was 20.3%,39 cases had fine prognosis, effective rate was 49.4%; 198 cases were 40-60 years old,52cases of them died, mortality rate was 26.3%,97 cases had fine prognosis with effective rate of 48.9%; 27 cases over 60 year old died, mortality rate was 22.7%,51 cases had fine prognosis and the effective rate was 42.9%. Through layering Chi-square test, there was no statastical significance between the mortality rate and effective rate, identifing that age was not a determine factors on prognosis of patients with severe intraventricular hemorrhage.2.2179 cases had GCS score 3-5 points,51 cases of them died, mortality rate was 28.5%,89 cases had fine prognosis with the effective rate of 49.7%; 217 cases had GCS score 6-9 points,44 of them died, mortality rate was 20.2%,98 cases had a fine prognosis, the effective rate was 45.2%. The mortality rate and the effective rate between the two groups showed P>0.05, identifing the difference possessed no statistical significance. The GCS score had no significant influence on the prognosis of severe intraventricular hemorrhage.2.3272 cases performed surgery within 6 hours,36 cases died, with mortality rate of 13.2%,151 cases had fine prognosis with an effective rate of 55.5%; 124 cases performed surgery after more than 6 hours,59 cases died, mortality rate was 47.6%, 36 cases had fine prognosis and effective rate was 29.0%. Mortality rate and the effective rate of the two groups possessed statistical significance respectively.2.4 There were 87casess orrurred rebleeding within 24 hours after the operation, and 31 cases of them died, mortality rate was 35.6%,22 cases had fine prognosis whit an effective rate of 25.2%; 309 cases didn’t occur rebleeding within 24 hours,64 cases of them died, mortality rate was 20.7%,165 cases had fine prognosis with the effective rate of 53.4%. Mortality rate and the effective rate of the two groups possessed statistical significance respectively.2.5 Bilateral and unilateral EVD Comparison between drainage tube stay time and hematoma clearance timeMean time of bilateral drainage placeing was 8.2±3.2 days, while average time of intraventricular hematoma absorption was 7.1±2.7 days; however, mean time of one-side drainage placeing was 14.3±5.7 days, and average time of intraventricular hematoma absorption was 11.4±3.2 days. Comparing the two results, there’s statwastic indication(P<0.05), indicating bilateral drainage was faster than unilateral drainage on hematoma clearance with shorter drainage time.2.6301 cases had application of urokinase,59 cases of them died and mortality rate was 19.6%,149 cases had fine prognosis, the effective rate was 49.5%; 95 cases didn’t use urokinase,36 cases of them died and mortality rate was 37.8%,38 cases had fine prognosis, the effective rate was 40%. Compared the two results, mortality rate possess a statistical significance while not the effective rate, identifing that early application of urokinase could reduce the mortality rate of patients with severe intraventricular hemorrhage, but would not significantly improve the overall prognosis.2.7 The average stay time of catheter of cases using urokinase was 7.9±3.2 days, mean time of hematoma absorption was 5.2±3.7 days; Those who didn’t use urokinase, the mean time of catheter placing was 15.2±6.1 days, mean time of hematoma absorption was 11.2±4.2 days. Tube placing time and hematoma absorption time both possessed statistical significance (P<0.05).2.8 Intracranial infection occurred in 18 cases,3 cases of them died, mortality was 16.7%,4 cases had fine prognosis with the effective rate of 22.2%; 378 cases did not occur intracranial infection,15 cases of them died, mortality rate was 3.9%,182 cases had fine prognosis with the effective rate of 48.1%. Mortality rate and the effective rate of the two groups possessed statistical significance respectively.3.Comparason of influencing factors of intracranial infection and bacterias3.1 Relationship between stay time of the tube and intracranial infectionAccording to the time of drainage, cases were divided into 4 groups (≤7 days,8-14 days,15-20 days and≥21 days) and their incidence rate of intracranial infection was recorded. Results showed that≤7 days group and≥21 days group had higher intracranial infection rate than the other two groups. But there’s no identifing difference among the 4 groups.3.2 Relationship between tube blockage and intracranial infection71 cases occurred drainage tube blockage during treatment, in which 7 cases attacked intracranial infection with infection rate of 9.9%; 325 cases’ drainage tube without blockage and only 11 cases occurred intracranial infection with infection rate of 3.4%. There’s significant difference btween the two group(P<0.05), identifing blocked tube may increase the occurrence of intracranial infection. 3.3. Cultivate results of intracranial infecionThere were 18 cases of intracranial infection totally, overall infection rate was 4.5%. Which include 11 cases of positive results,4 cases of Staphylococcus epidermidas,2 cases of Staphylococcus aureus,1 case of Hemolytic staphylococcus,2 cases of Escherichia,1 case of Klebsiella pneumoniae,1 case of single Pseudomonas maltophilia.Conclusions1. Rapid pore cranial drilling external ventricular draniage was time saving, simple, instant implementation and it was an effective means to cure patients with severe intraventricular hemorrhage.2. Different age patients with no significant difference in mortality and response rate, there’s no significant effect between age and prognosis to patients with severe intraventricular hemorrhage.3. There’s no sigificant relationship between preoperative GCS and outcome for severe intraventricular hemorrhage.4. Placing lateral ventricle drainage as early as possible after the onset(within 6h) to reduce the mortality rate and improve the prognosis.5. Postoperative rebleeding within 24 hours may increase mortality rate, affecting patients’prognosis.6. Bilateral ventricular drainage was faster in hematoma clearance and shorter on tube remaining time than unilateral drainage.7. Urokinase Infusing into the cerebral ventricle could accelerate the hematoma absorption, reduce the intubation time and lower the death rate, but the overall improvement on prognosis was not clear.8. Tube blockage occuring in the treatment could increase the occurrence of intracranial infection which could increase the mortality rate and influence patients’prognosis. Staphylococci was the common type of bacteria leading intracranial infection and it may always be multi-drug resistant bacteria.更多还原