| Background and Objective:Intraventricular hemorrhage (IVH) is a very common and severe event, with a high incidence and poor prognosis. Clinical studies have shown that external ventricular drainage (EVD) is a treatment method aimed at removing intraventricular clots rapidly by draining it out of brain to relieve the mass effect, and as the result that cerebrospinal fluid circulation can be resumed as soon as possible, and cerebral edema and toxic effects of various metabolites could be reduced. The effectiveness of the EVD as a core means of surgical treatment for severe IVH has been widely recognized, but influencing factors related to the EVD drainage duration and catheter-related intraventricular infection (CRVI) are still debated. In this retrospective investigation, the relationships among the EVD duration, the sites of IVH, and the occurrence of CRVI were investigated to provide a proper suggestion for clinical decision-making in future.Materials and methods:in this retrospective investigation, a total of403patients with IVH were enrolled from October2008to January2012according to medical records. Finally,120patients were enrolled according to the inclusive criteria. In order to investigate the difference among IVH sites, all cases were divided into three groups according to the intraventricular hemorrhage sites:A. lateral ventricle group; B. the third ventricle group; C. the fourth ventricle group. Grouping criteria was according to the modified Graeb criteria, the site of the highest score was selected by comparing the bilateral ventricles score, the score of the third and fourth ventricles, select one of the site of the highest score as main hematocele site, and her position was regarded as the main location of hematocele and medical records was divided into the corresponding group; if the score of two or more parts were equal, the CT values of the center of intraventricular hematocele in the CT scan is used as a additional criteria, CT values higher position was regarded as the main location of hematocele and medical records was divided into the corresponding group. To study the relationship among the EVD duration and CRVI incidence and score of IVH by modified Graeb criteria, all cases were divided into four groups according to the EVD duration:drainage Within7d group;8-14d group;15-21d group;22d above group. Using Nonparametric test and Bonferroni method of pairwise comparison to investigate the relationships of EVD duration among IVH sites, and using the Spearman correlation analysis to study the relationships between EVD duration and score of IVH by modified Graeb criteria, the difference of CRVI incidence and catheter obstruction incidence was evaluated by Chi-square test and Fisher’s exact test.Result:1. The relationship between EVD duration and the sites of IVH120cases were entered the statistical process. In the lateral ventricle group of33cases, the average EVD duration was7.30±3.04days; in the third ventricle group of42cases, the average EVD duration was14.55±7.82days; in the fourth ventricle group of45cases, the average EVD duration was13.60±5.61days. There was a significant difference among the three groups was statistically significant (X2=42.217,P<0.01). According to the Bonferroni method, there was significant difference (P<0.01)between the lateral ventricle group and the third ventricle group; there was significant difference (P<0.01)between the lateral ventricle group and the fourth ventricle group; but there was no significant difference between the third ventricle group and the fourth ventricle group (P>0.05).2. The relationship between the EVD duration and score of IVH by the modified Graeb criteria Spearman rank correlation test showed that the EVD duration and score of IVH by modified Graeb were positively related (Rs=0.444, p=0.000, P<0.01).Rs ranged from0.3to0.5, suggested that the two had moderately positive correlation, and indicated that the higher score of IVH by the modified Graeb criteria was, the worse the illness was, and more EVD duration was needed.3. The relationship between the EVD duration and incidence of CRVI In120cases,10cases had CRVI, accounting for8.33%of the whole patients; in25cases of drainage7d group,3cases had CRVI, accounting for12.00%; in68cases of14d group,3cases had CRVI, accounting for4.41%; in20cases of15-21d group,2cases had CRVI, accounting for10.00%; in7cases of more than22d group,3cases had CRVI, accounting for28.57%. The results indicated that there is no significant difference among the four groups,(X2test, X2=42.217, p=0.079, P>0.05,).but the occurrence of CRVI was high in the group of longer duration of EVD. 4. The relationship between the sites of IVH and incidence of catheter obstruction events In120cases,13cases had catheter obstruction events, accounting for10.83%; in the lateral ventricle group consisted of33patients,8cases had catheter obstruction events, accounting for24.24%; in the third ventricle group consisted of42cases,2cases had catheter obstruction events, accounting for4.76%; in the fourth ventricle group consisted of42cases,3cases had catheter obstruction events, accounting for6.67%. The results showed that there was statistically significant difference between the sites of IVH and incidence of catheter catheter obstruction events. The data showed that the probability of catheter obstruction events of the lateral ventricle group was significantly higher than other groups.5. The relationship between CRVI and catheter obstruction Events In120cases, CRVI occurred in10cases, catheter obstruction event occurred in13cases. Corrected chi-square test, X2=33.135, P <0.01, The results showed that there was statistically significant difference between CRVI and catheter obstruction events, The data showed that catheter obstruction events is positively related to the occurrence of CRVI.6. The relationship between the main hematocele sites and incidence of CRVI In120cases,10cases in the fourth ventricle had CRVI, accounting for8.33%of the whole; in the lateral ventricle group consisted of33cases,7cases had CRVI, accounting for21.21%; in the third ventricle group consisted of42cases,2cases had CRVI, accounting for4.76%; in the fourth ventricle group consisted of45cases,1case had CRVI, accounting for2.22%. The result of the Fisher exact test, X28.320, P<0.05, the results showed that there was statistically significant difference between the main hematocele sites and incidence of CRVI. The data showed that the probability of CRVI events of the lateral ventricle hemorrhage parts was significantly higher than other groups. Conclusions1. EVD duration for IVH patients should be made according to the IVH site. It is a proper selection that the EVD duration was about week for the patients with main blood clots in the lateral ventricle, and it was not more than2weeks for the patients with main blood clots in the third ventricle or the fourth ventricle.2.The score of IVH by the modified Graeb criteria is a important factor for EVD duration.3. The probability of catheter obstruction event is higher in patients with main plot in the lateral ventricle than those in the third or the forth ventricle. And catheter obstruction event is a important factor for CRVI. |
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