Application Study Of Continuous Lumbar Cistern Drainage In The Rupture Of Hypertensive Intracerebral Hemorrhage Into The Ventricle

Objective: To observe the clinical efficacy of continuous lumbar cistern drainage in patients with hypertensive cerebral hemorrhage into the ventricle for non-surgical treatment,so as to provide scientific basis for clinical application and promotion of continuous lumbar cistern drainage in patients with hypertensive cerebral hemorrhage.At the same time,determine the suitable placement time and extraction time of lumbar cistern drainage tube.Methods: Collected from October 2015 to October 2017,Chengdu second people’s hospital neurosurgery admitted,have a history of hypertension or admitted to the hospital diagnosed as hypertension,and confirmed by the head CT hypertensive intracerebral hemorrhage into the ventricle,and non-surgical treatment of patients;42 patients were selected as lumbar cistern group and 38 patients were selected as lumbar puncture group.All patients were given routine basic treatment upon admission.During the treatment,headache duration,cerebrospinal fluid clearance time,intracranial infection and hydrocephalus were observed dynamically in each group,and the treatment plan was adjusted dynamically with the results of CT scan.The hospitalization time of each group was counted.The dosage of mannitol and the incidence of mannitol-related complications in each group were statistically analyzed.The discharged patients were followed up regularly and CT was performed to find out whether hydrocephalus was present or not.GOS prognostic score was used to evaluate the short-term prognosis at 3 months and ADL grading was used to evaluate the long-term clinical outcome at 6 months.The clinical data of each group were collected and analyzed by SPSS 19.0 software,whether there was significant difference between the two groups was compared.At the same time,the time of drainage tube placement and removal was observed during the treatment and analyzed and evaluated in parallel system.Results:(1)There was no significant difference between the two groups(P(29)0.05)in general data such as gender,age,bleeding site,bleeding volume,GCS score,Graeb score,admission time,operation(catheterization,lumbar puncture)start time,etc.(2)There were statistically significant differences in headache duration,cerebrospinal fluid clearance timeand hospitalization time beween the two groups(P(27)0.05).(3)There was statistically significant difference in mannitol dosage beween the two groups(P(27)0.05).(4)Compared the incidence of hydrocephalus beween the two groups,the lumbar cistern group was less than the lumbar puncture group,and the difference was statistically significant(P(27)0.05).(5)There was no significant difference between the incidence of intracranial infection in lumbar cistern group and lumbar puncture group(P(29)0.05).(6)The short-term clinical efficacy of the two groups were compared: the total effective rate of lumbar cistern group was 100% at 3 months,with good recovery of 80.95%,the total effective rate of lumbar puncture group was 89.47%,with good recovery of 71.05%;the total effective rate of lumbar puncture group was significantly different from that of lumbar puncture group(P(27)0.05),but there was no significant difference in short-term recovery(P(29)0.05).(7)Comparison of long-term clinical outcomes between the two groups: The recovery rate in the lumbar cistern group was 95.24% at 6 months,one case died,the recovery rate in the lumbar puncture group was 76.31%,and one died.There was statistically significant difference in long-term recovery rate between the two groups(P(27)0.05),and there was no statistical difference in mortality rate(P(29)0.05).(8)Observation showed that the placement time of lumbar cistern drainage tube was 2~6 days after admission,with an average of4.17±1.04 d,and the extubation time was 5~13 days after placement,with an average of8.10 ± 1.87d;After placement and extubation,the condition was stable,no obvious symptoms aggravated,suggesting the right time.Conclusion:(1)CLD can rapidly and effectively eliminate intraventricular hemorrhage,improve headache symptoms,shorten hospitalization time,reduce the occurrence of chronic hydrocephalus and significantly improved long-term prognosis;(2)CLD can reduce mannitol dosage,and then reduce the incidence of related complications;(3)CLD should be regarded as a good adjuvant therapy in non-operative treatment of intraventricular hemorrhage;(4)CLD had no significant effect on the incidence of intracranial infection,mortality rate and good recovery in the near future in non-operative treatment of intraventricular hemorrhage;(5)The lumbar cistern drainage tube should be placed as early as possible in order to reduce the pain of repeated LP and the injury caused by puncture.