Comparison and contrast of different treatments for severe spontaneous cerebellar hemorrhage with intraventricular hemorrhage in elderly patients
10.3760/cma.j.issn.0254-9026.2018.05.014
- VernacularTitle:老年患者小脑出血破入脑室时不同治疗方法疗效对比研究
- Author:
Long WANG
1
;
Jianjian ZHANG
;
Zhibin SONG
;
Jianwei GAO
;
Xuguang LI
;
Fang WANG
Author Information
1. 山西省长治医学院附属和平医院神经外科
- Keywords:
Brain hemorrhage;
Plasminogen activators;
Perfusion;
Prognosis;
External ventricular drainage
- From:
Chinese Journal of Geriatrics
2018;37(5):539-543
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare four therapies for elderly patients with cerebellar hemorrhage breaking into the ventricles.Methods Clinical data of 158 elderly patients with severe spontaneous cerebellar hemorrhage breaking into the ventricles were retrospectively analyzed.There were 28 cases in the conservative management (CM) group and 130 cases in the surgical therapy (ST) group with an external ventricular drainage (EVD) subgroup (n=40),an external ventricular drainage combined with intraventricular fibrinolysis (EVD + IVF) subgroup (n =43),and a clot evacuation (CE) subgroup (n=47).The mortality at 1 month and modified Rankin Scale (mRS) at 6 months were employed to evaluate clinical effectiveness.In addition,statistical analysis of correlative factors for prognosis was conducted.Results The 1-month mortality (x2 =7.529,P =0.006) and 6-month mRS in the CM group (x2 =4.819,P =0.028) were significantly higher than those in the ST group.There was no significant difference in mortality after one month among the three ST subgroups (x2 =0.143,P=0.931),whereas significant differences were observed in 6-month mRS among them (x2 =7.209,P=0.027),and the scale in the EVD+IVF subgroup was significantly lower than in the CE and EVD subgroups.The incidence of complications such as pulmonary infections and stress ulcers in the CM group was significantly higher than in the ST group.Statistical differences were found in the incidence of pulmonary infections among the three ST subgroups (x2 =6.694,P=0.035),and the incidences in the EVD subgroup and the EVD+IVF subgroup were lower than the incidence in the CE subgroup.Nevertheless,there was no significant difference in the incidence of stress ulcers among the three ST subgroups (x2 =0.547,P=0.776).Conclusions EVD+ IVF is an effective treatment for cerebellar hemorrhage breaking into the ventricles in elderly patients,especially for those who cannot withstand a craniotomy or those who have primary diseases.It may speed up the absorption of hematoma,and decrease the operative risk and the incidence of postoperative complications.
