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Objective To investigate the efficacy of neuroendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage.Methods From August 2014 to August 2017,91 spontaneous thalamic hemorrhage ruptured into ventricles patients in Affiliated Hospital of the Yangzhou University were enrolled,who were underwent surgical treatment in this retrospective study.The patients were divided into the study group(n =41) and control group(n =50) based on different methods of treatment.The patients in the study group were given with remove visible intraventricular hematoma by neuroendoscopy,followed by External Ventricular Drainage (EVD) combined with urokinase fibrinolysis.The patients in control group were given with EVD combined with urokinase fibrinolysis.The time of postoperative drainage,ICU stay,duration of onset of fever,the number of intracranial infections,and the proportion of Glasgow outcome scale (GOS) (1 to 5) at 6 months postsurgery were compared between two groups.Measurement data were expressed as (Mean ± SD),and t test was used for measurement data.The count data were analyzed by x2 test or nonparametric rank sum test.Results The time of postoperative drainage,the number of intracranial infections,ICU stay in study group were (6.19 ± 1.1) d,5 cases,(2.8 ± 1.6) d,the indexes in control group were (7.06 ± 1.3) d,15 cases,(5.2 ± 2.0) d.The time of postoperative drainage,ICU stay,the number of intracranial infections were superior to those of the control group,and the difference was statistically significant.The proportion of GOS (1 to 5) at 6 months after surgery was 5 cases (12.2％),5 cases (12.2％),10 cases (24.4％),14 cases (34.1％),7 cases (17.1％) in study group,the indexes in control group were 10 cases(20.0％),13 cases (26.0％),11 cases(22.0％),10 cases(20.0％),6 cases(12.0％).The 6-month postoperative GOS of the study group were superior to those of the control group,and the difference was statistically significant (P ＜ 0.05).Conclusion Neruendoscopy combined with urokinase in the treatment of spontaneous intraventricular hemorrhage can reduce the time of postoperative drainage and the incidence of intracranial infection,shorten the time of ICU stay and improve the functional prognosis of the patients.
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Objective To investigate the strategy and efficacy of enteral nutrition support of patients with spontaneous intraventricular hemorrhage-induced coma.Methods 139 patients were randomly divided into study group (treated with enteral nutrition mixed suspension,n =67) and control group (treated with normal full nutritional homogenized product,n =72) with a random number generating software.Enteral nutrition support was administered in 6-48 hours after admission.The total daily intake of enteral nutrition preparation was 1 000 ml (4 186.8 kJ),supplemented by liquid food.Body weight,serum albumin,serum total protein,hemoglobin,lymphocyte count,incidence of infection,level of consciousness and incidence of complications were compared between the two groups.Results In the third week after onset,the serum albumin [(32.1 ± 3.3) g/Lvs.(30.5±2.3) g/L,P=0.041],total protein [(62.2±3.2) g/Lvs.(56.9±2.7) g/L,P=0.039],and hemoglobin [(125.5 ±5.7) g/Lvs.(120.7 ±6.4) g/L,P=0.027] were significantly higher in the study group than in the control group.The Glasgow score in the second week in the study group was 13.1 ± 1.9,significantly higher than that in the control group (11.0 ±2.3) (P =0.037);the incidence of nosocomial infection was significantly lower in the study group than in the control group [17.9％ (12/67) vs.29.2％ (21/72),P =0.021];the proportion of patients with abnormal blood test results and that of patients having fever for more than 7 consecutive days were both significantly lower in the study group than in the control group [31.3％ (21/67) vs.38.8％ (28/72),P=0.042;37.3％ (25/67) vs.41.7％ (30/72),P =0.047].The two groups showed no significant difference in the incidence of intracranial infection after external ventricular drainage (P =0.235).Conclusion For patients with spontaneous intraventricular hemorrhage-induced brain dysfunction,enteral nutrition support with enteral nutrition suspension could effectively improve nutritional status,reduce complications,therefore conducive to recovery.
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The authors analysed retrospectively 41 cases of spontaneous IVH(intraventricular hemorrhage) which were treated with EVD(extraventricular drainage). In cases of poor drainage of CSF(cerebrospinal fluid) through the EVD catheter, infusion of urokinase was tried. The most common age groups of IVH patients were the 5th and 6th decades. Sexual incidence was 23 : 18 in male vs. female. The etioligies of the spontaneous IVH in order of frequency were hypertension, aneurysm rupture, AVM. The overall mortality rate was 49%, but a poor outcome was noted in 64% of the cases. The cases of high Graeb score & low GCS(Glasgow coma scale) score on admission showed poor outcome. Incidence of complication was 27%. Ventriculostomy was effective in many cases of IVH, especially in the early stage of stroke.