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:目的 :探讨原发性脑室内出血的病因及其治疗效果。方法 :对 1995～ 1999年我科收治的2 6例经 CT证实的原发性脑室内出血病例进行总结。结果 :病因首推高血压 (占 6 5.4 % ) ,其次为动静脉畸形 (占 11.5% ) ,不明病因者占 2 3.1%。疗效 :1保守治疗 14例 ;GOS5分者 11例 ,4分者 1例 ,1分者 2例。 2单纯侧脑室外引流 9例 ;GOS5分者 4例 ,4分者 1例 ,3分者 1例 ,2分者 1例 ,1分者 2例。 3采取急诊开颅血肿清除、AVM切除、脑室外引流者 3例 ;GOS5分者 2例 ,4分者 1例。结论 :对于非 AVM或动脉瘤性 PIVH的治疗方法选择 ,我们认为 :1只要没有伴发急性梗阻性脑积水 ,即使病人为全脑室出血和 (或 )伴有轻度意识障碍 ,也应暂时采用保守治疗。 2对于伴发轻或中度脑积水者 ,是否手术应结合患者意识障碍及动态 CT所见决定。 3对于无伴发急性梗阻性脑积水的患者 ,过度积极的脑室外引流有加重脑室内再出血的危险。
Objective: To explore the etiology and treatment of primary intraventricular hemorrhage. Methods: 26 cases of primary intraventricular hemorrhage confirmed by CT in our department from 1995 to 1999 were summarized. Results: Etiology was the most important cause of hypertension (6 5.4%), followed by arteriovenous malformations (11.5%) and unidentified causes (23.1%). Efficacy: 1 conservative treatment in 14 cases; GOS5 points in 11 cases, 4 points in 1 case, 1 point in 2 cases. 2 cases of lateral ventricle drainage in 9 cases; GOS5 points in 4 cases, 4 points in 1 case, 3 points in 1 case, 2 points in 1 case, 1 point in 2 cases. 3 to take emergency craniotomy hematoma removal, AVM resection, intraventricular dilatation in 3 cases; GOS5 points in 2 cases, 4 points in 1 case. CONCLUSIONS: For treatment options for non-AVM or aneurysmal PIVH, we believe that: 1 As long as there is no acute obstructive hydrocephalus, even if the patient is whole brain ventricular hemorrhage and / or accompanied by mild disturbance of consciousness, Adopt conservative treatment. 2 For those with mild or moderate hydrocephalus, surgery should be combined with patients with unconsciousness and dynamic CT findings. 3 For patients with uncomplicated acute obstructive hydrocephalus, over-aggressive extracerebral ventricular drainage may aggravate the risk of intraventricular rebleeding.