External Ventricular Drainage Combined With Lumbar Cistern Drainage In The Treatment Of Intraventricular Hemorrhage

Objective: Ventricular hemorrhage is common in neurosurgical diseases,characterized by acute and critical morbidity,mortality and morbidity.After hemorrhage,the physical action of intraventricular blood clots obstructs the normal circulation of cerebrospinal fluid,resulting in the occurrence and development of acute obstructive hydrocephalus.If the ventricle is filled with blood cerebrospinal fluid,resulting in the formation of ventricular cast,the mortality rate is significantly increased.At present,the treatment of intraventricular hemorrhage includes basic management and surgical treatment,and basic management such as dehydration to reduce intracranial pressure,lowering blood pressure,hemostasis,and oxygen inhalation.At present,external ventricular drainage is more commonly used in surgical treatment,but its drainage effect is poor and cannot improve the prognosis of patients,while continuous lumbar cistern catheter drainage can increase the hematoma clearance rate and prolong the drainage time of cerebrospinal fluid,so as to make up for the lack of external ventricular drainage alone and reduce the ventricular infection rate and the incidence of hydrocephalus.The main purpose of this study is to retrospectively analyze the feasibility of continuous lumbar cistern catheter drainage in the treatment of ventricular hemorrhage,and to explore the clinical efficacy of continuous lumbar cistern catheter drainage in the treatment of ventricular hemorrhage by comparing continuous lumbar cistern catheter drainage combined with external ventricular drainage with external ventricular drainage alone.Methods: A total of 80 patients with ventricular hemorrhage admitted to the Affiliated Hospital of Yan'an University from January 2015 to January 2019 were retrospectively analyzed.According to different surgical methods,the patients weredivided into observation group(n = 40)and control group(n = 40).The patients in observation group received external ventricular drainage(EVD)combined with continuous lumbar cistern catheter drainage(CLD).All patients in control group received EVD alone.All patients were given ECG monitoring immediately after admission.Consciousness and pupillary changes were observed.Oxygen inhalation,blood pressure control,dehydration to reduce cranial pressure,acid suppression and other basic management were performed.After no obvious surgical contraindications,all patients underwent emergency EVD.Unilateral EVD was performed in patients with hemorrhage involving one lateral ventricle and no obstruction of the foramen of Monro;EVD was performed in patients with hemorrhage involving both lateral ventricles.In both groups,urokinase 20,000 U and 0.9% normal saline 3-4 ml were injected into the external ventricular drainage tube under aseptic conditions to dissolve the hematoma after 12 hours of EVD placement,and then the external ventricular drainage tube was clamped for 3-4 hours,once or twice a day for 2-3 consecutive days.When CT confirmed that the third and fourth ventricular blood clots basically disappeared(generally 3-5 days after EVD),bedside continuous lumbar cistern catheter drainage was performed.The general conditions of patients in the two groups were compared,and the lateral ventricular drainage time,incidence of hydrocephalus and incidence of intracranial infection were calculated in the two groups,respectively.Glasgow Outcome Scale(GOS)and Activities of Daily Living Scale(ADL)were followed up by telephone after 6 months,and the prognosis of the two groups was analyzed.Results: Statistical analysis showed:(1)There was no significant difference in gender,age,admission Glasgow Coma Scale(GCS)score,modified Graeb score,bleeding site and blood loss between the two groups(P > 0.05);(2)The external ventricular drainage time in the control group was significantly longer than that in the observation group(P < 0.05);(3)Complications,the incidence rate of hydrocephalus in the two groups had statistical significance(P < 0.05),and the incidence rate of hydrocephalus in the observation group was significantly lower than that in the control group.There was no significant difference in the intracranial infection rate between thetwo groups(P > 0.05);(4)The follow-up results after 6 months showed that the prognosis of the observation group was better than that of the control group.After GOS score,the recovery rate of the observation group was significantly higher than that of the control group(P < 0.05).The results of ADL score showed that the patients in the observation group recovered well significantly more than those in the control group(P <0.05).Conclusion:1.Continuous lumbar cistern catheter drainage can shorten the time of external ventricular drainage,thereby reducing the incidence of complications of external ventricular drainage.Continuous lumbar catheter drainage can prolong the drainage time of cerebrospinal fluid and make hematoma evacuation more thorough.2.Continuous lumbar catheter drainage can make the cerebrospinal fluid return to normal circulation faster,and form a pressure difference,which has the effect of washing and drainage of blood cerebrospinal fluid and reduces the incidence of hydrocephalus.In addition,through timely and effective drainage,the secondary damage of neurotoxic substances in the blood to the brain tissue can be reduced.By improving the hematoma clearance rate and reducing complications,the prognosis of patients is significantly better and the quality of life is improved.