| Intraventricular hemorrhage is a common neurosurgery emergency. It is classified to the primary and the secondary intraventricular hemorrhage according to the different location of bleeding. The mortality rate and disability rate of IVH is very high, the overall mortality rate is 32%~44%, and the IVH has a poor prognosis. Furthermore, the therapy for IVH is intractable, so it is a great challenge for neurosurgeons. The traditional and effective treatment of intraventricular hemorrhage is external ventricular drainage, draining the blood and cerebrospinal fluid from the ventricular system to control the intracranial pressure. But the current clinical guidelines do not explicitly refer to the unilateral or bilateral drainage tubes for the IVH should be placed. At present, the comparison of the drainage efficiency between unilateral external ventricular drainage and bilateral external ventricular drainage, the incidence of complications and the prognosis are not clear. Objective:To explore the differences of the drainage efficiency, the incidence of complications, the prognosis between unilateral external ventricular drainage and bilateral external ventricular drainage in surgical treatment of intraventricular hemorrhage, in order to provide basis and guidance for the clinical treatment of IVH with unilateral external ventricular drainage or bilateral external ventricular drainage. Dates and Methods:Retrospective analysis the data of 56 patients with intraventricular hemorrhage treated by external ventricular drainage surgery in No.1 Hospital of Jilin University from October 2013 to October 2015.There are 37 males and 19 females, and the age ranged from 39 to 78 years old. The average age of the two groups was 55.1±8.2 years old and 55.8±10.8 years old. 24 cases were treated by unilateral external ventricular drainage(group of single drainage tube), 32 cases were treated by bilateral external ventricular drainage(group of double drainage tubes). Before the surgery, the patients of two groups were performed in Glasgow Coma Scale(GCS) and the modified Graeb score, to compare the severity of the disease. The traditional frontal ventricle drainage was used, and the urokinase will be injected into the ventricles of the brain after the surgery. Calculating the hematoma clearance rate, the rate of intracranial infection, the bleeding rate of puncture, the rate of rehaemorrhagia, the rate of pulmonary infection, GOS score at discharge, 3 months follow-up GOS score, the incidence of hydrocephalus and the mortality, and then the two groups were compared with the corresponding statistical analysis. Results:1、GCS scores and Graeb scores were compared between the two groups before operation, the difference was not statistically significant(P>0.05).2、The average clearance rate of hematoma in group of single drainage tube was 75.2%±9.1%, and the average clearance rate of hematoma in group of double drainage tubes was 77.8%±13.3%, there was no significant difference between the two groups(P>0.05).3、The average duration of catheter drainage in group of single drainage tube was 5.0±1.8 days, and it was 6.8±2.2 days in the other group, two groups had statistically significant difference(P<0.05).4、The average daily volume of drainage in the group of single drainage tube was 124.6±41.0ml,it was 139.6±42.3ml in the other group, there was no significant difference between the two groups(P>0.05).5、The times of injecting the urokinase in the group of single drainage tube was 2.1±1.1,and it was 2.2±1.3 in the group of double drainage, there was no significant difference between the two groups(P>0.05).6、The average hospitalization days in the ICU of the patients with single pipe group was 10.6±3.7 days, the average hospitalization days in the ICU of the patients with double tube groups was 13.3±5.1 days, two groups had statistical significance difference(P<0.05).7、There was 0 case of intracranial infection in the group of single drainage tube and 7 cases of intracranial infection in the other group, the difference between two groups have statistical significance(P<0.05).8、One patient got the bleeding of puncture in the group of single drainage tube, and there were 9 patients got the bleeding of puncture in the group of double drainage tubes, the difference between two groups have statistical significance(P<0.05). 9、There were was 2 cases of rehaemorrhagia in the group of single drainage tube and 3 cases of rehaemorrhagia in the group of double drainage tubes, there was no significant statistical differences between the two groups(P>0.05).10、There were 16 patients got pulmonary infection in the group of single drainage tube and 27 patients got pulmonary infection in the group of double drainage tubes, there was no significant statistical differences between the two groups(P > 0.05).11 、 The GOS score at discharge was 3.8±1.0 in the group of single drainage tube, and it was 2.8±0.9 in the group of double drainage tubes, the difference between two groups have statistical significance(P<0.05).12、No deaths within 30 days after discharge in the group of single drainage tube, and 3 patients were dead in the group of double drainage tubes, 1 of them died in hospital and 2 died after discharge,there was no significant difference in mortality between the two groups(P>0.05).13、3 months follow-up GOS score was 3.9±1.1 in the group of single drainage tube, it was 3.4±1.1 in the group of double drainage tubes, there was no significant difference between the two groups(P>0.05).14、One patient in the single drainage group and 2 patients in the double drainages group were complicated with hydrocephalus within 3 months after discharge, there was no significant difference between the two groups(P>0.05). Conclusion:External ventricular drainage is an effective method to treat the intraventricular hemorrhage complicated with hydrocephalus, and there was no significant difference in the rate of hematoma clearance between the unilateral external ventricular drainage and bilateral ventricular external drainage. The average duration of catheter drainage, the average hospitalization days in the ICU,the rate of intracranial infection and the rate of puncture bleeding in the group of double drainages were higher than the other group. The rate of rehaemorrhagia, the rate of pulmonary infection, incidence of hydrocephalus, the 30-day mortality, 3 months follow-up GOS score, the times of injecting the urokinase had no statistically significant difference between two groups. |
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