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目的探讨阿司匹林相关性脑室出血合并急性脑积水行脑室外引流术后再出血的原因及补救措施。方法回顾性分析58例长期口服阿司匹林患者发生脑室出血合并急性梗阻性脑积水的临床资料,根据急诊脑室外引流术后血肿情况选择不同补救措施分为显微镜清除组,尿激酶灌注组,维持脑室引流组。分析血小板与冷沉淀使用情况,血肿清除时间,再出血,颅内感染,临床结局及出血3个月时GOS评分等。结果 58例患者急诊行额部双侧脑室穿刺外引流术后血肿较术前明显增大41例,血肿无明显变化6例,明显血肿减少11例;采取开颅显微镜下清除血肿21例,脑室尿激酶灌注20例,维持脑室外引流12例。共有35例患者在治疗过程中使用新鲜血小板和冷沉淀。腰大池持续引流13例。颅内感染尿激酶脑室灌注组发生率最高(P<0.05),脑室血肿清除时间显微镜清除组时间最短(P<0.05)。比较三组GOS评分、再出血发生率等差异无统计学意义(P>0.05)。结论阿司匹林相关性脑室出血合并急性梗阻性脑积水患者,急诊脑室外引流术后再出血机率较高;对再出血患者选择开颅显微镜下清除或经脑室灌注尿激酶溶血治疗疗效相近,及时输入新鲜血小板与冷沉淀,可减少再出血,但显微镜下清除血肿迅速优势更大,是更为有效的补救措施。
Objective To investigate the causes and remedies of aspirin-related intraventricular hemorrhage combined with acute hydrocephalus after cerebral ventricular drainage. Methods The clinical data of 58 patients with long-term oral aspirin and acute obstructive hydrocephalus were retrospectively analyzed. Microsurgery group, urokinase-infusion group and maintenance of ventricle were selected according to the different remedial measures according to the situation of hematoma after emergency outdoor ventricular drainage. Drainage group. Analysis of platelet and cryoprecipitate use, hematoma removal time, rebleeding, intracranial infection, clinical outcome and bleeding 3 months GOS score. Results Fifty-eight patients underwent emergency department of the department of double-ventricle puncture after external drainage hematoma significantly increased 41 cases compared with preoperative, no significant changes in hematoma in 6 cases, 11 cases of obvious hematoma reduction; take craniotomy microscope in 21 cases of hematoma removal, ventricular Urokinase perfusion in 20 cases, to maintain ventricular drainage in 12 cases. A total of 35 patients used fresh platelets and cryoprecipitate during treatment. Continuous lumbar drainage in 13 cases. The intracranial infection of urokinase had the highest incidence of ventricular perfusion (P <0.05), and the shortest time of clearing time of ventricular hematoma (P <0.05). There was no significant difference between the three groups in GOS score and the incidence of rebleeding (P> 0.05). Conclusions Aspirin-associated intraventricular hemorrhage combined with acute obstructive hydrocephalus is more likely to cause rebleeding in patients with emergent extracerebral venous drainage. For patients with rebleeding, the patients who underwent craniotomy or clear-cut percutaneous transluminal urokinase hemolysis had similar therapeutic effect and promptly input Fresh platelets and cryoprecipitation can reduce rebleeding, but the advantages of a clear hematoma under the microscope more quickly, is a more effective remedy.