뇌실내출혈의 치료에 있어 뇌실도관법에 대한 고찰

Abstract

[한글]

The effect of constant ventricular drainage for the patients of intraventricular

hemorrhage

Yong Pyo Han

Department of Medical Science The Graduate School Yonsei University

(Directrd by Prof. Hun Jae Lee, M.D.)

Among all of the cerebrovascular problem that which has the highest mortality and

worst prognosis is the problem of intraventricular hemorrhage. The mortality is

highest immediately following the hemorrhage.

Because direct surgical intervention is thought to be vary dangerous in patients

with intraventricular hemorrhage most of these patients have been treated

conservatively.

This study gives the result of evacuation of the intraventricular blood plus the

placement of external drainage catheters which decrease the intraventricular

pressure and provide an outlet for the blood should the patient have further

hemorrhage. Such a procedure is associated with clinical improvement which better

prepares such patients for subsequent surgical treatment.

Eighteen patients who had intreventricular hemorrhage between June 1973 and April

1974 are analyzed as to the results of this operative treatment. Also the

literature concerning this new method is reviewed.

The operative procedure was as follows:

Under local anesthesia using 1% procraine unilateral or bilateral burr holes were

made in the frontal area. Ventriculostomy was made through these holes. The

ventricle was irrigated with physiologic saline removing the hematoma or the bloody

ventricular fluid.

The irrigation was continued until the fluid became relatively clear. Following

the initial irrigation, the cannular was removed and a Nelaton catheter was fixed

to the scalp and connected to a drainage bottle under aseptic conditions. The

ventricular drainage was maintained at 200mmH^^2 O for 7-10 days.

Prior to surgery 2 million unite of procaine penicillin was injected into the

ventricle. Postoperatively, 5mg of Gentamycin was injected through the catheter

twice a day.

Surgical drainage of the ventricle was done 3 hours to 7 days after the onset of

clinical sings of hemorrhage. The external ventricular drainage was maintained for

an average of 7.0 days.

Results:

10 patients (56%) improved and could be discharged. 4 died of recurrent

intraventricular hemorrhage, of gastrointestinal bleeding, or of myocardial

infarction during hospitalization. However, all of these 4 patients showed some

clinical improvement following the operative procedure. Only "4" patients expired

after surgery. This mortality of 44%is considerably less than the usually found

mortality of 80-100% for intraventricular hemorrhage and 60-70% in subarachnoid

hemorrhage.

On the basis of this study a more active treatment of patients with

intraventricular hemorrhage, including operative drainage of the ventricle is

proposed.

[영문]

Among all of the cerebrovascular problem that which has the highest mortality and worst prognosis is the problem of intraventricular hemorrhage. The mortality is highest immediately following the hemorrhage.

Because direct surgical intervention is thought to be vary dangerous in patients with intraventricular hemorrhage most of these patients have been treated conservatively.

This study gives the result of evacuation of the intraventricular blood plus the placement of external drainage catheters which decrease the intraventricular pressure and provide an outlet for the blood should the patient have further

hemorrhage. Such a procedure is associated with clinical improvement which better prepares such patients for subsequent surgical treatment.

Eighteen patients who had intreventricular hemorrhage between June 1973 and April 1974 are analyzed as to the results of this operative treatment. Also the literature concerning this new method is reviewed.

The operative procedure was as follows:

Under local anesthesia using 1% procraine unilateral or bilateral burr holes were made in the frontal area. Ventriculostomy was made through these holes. The ventricle was irrigated with physiologic saline removing the hematoma or the bloody ventricular fluid.

The irrigation was continued until the fluid became relatively clear. Following the initial irrigation, the cannular was removed and a Nelaton catheter was fixed to the scalp and connected to a drainage bottle under aseptic conditions. The ventricular drainage was maintained at 200mmH^^2 O for 7-10 days.

Prior to surgery 2 million unite of procaine penicillin was injected into the ventricle. Postoperatively, 5mg of Gentamycin was injected through the catheter twice a day.

Surgical drainage of the ventricle was done 3 hours to 7 days after the onset of clinical sings of hemorrhage. The external ventricular drainage was maintained for an average of 7.0 days.

Results:

10 patients (56%) improved and could be discharged. 4 died of recurrent intraventricular hemorrhage, of gastrointestinal bleeding, or of myocardial infarction during hospitalization. However, all of these 4 patients showed some clinical improvement following the operative procedure. Only "4" patients expired

after surgery. This mortality of 44%is considerably less than the usually found mortality of 80-100% for intraventricular hemorrhage and 60-70% in subarachnoid hemorrhage.

On the basis of this study a more active treatment of patients with intraventricular hemorrhage, including operative drainage of the ventricle is proposed.