不同管径的脑室穿刺引流管对高血压脑室出血患者预后的影响

The Impact of Ventriculostomy Drainage Tubes with Different Diameters on the Prognosis of Patients with Hypertensive Ventricular Hemorrhage

摘要: 目的：探讨不同管径脑室穿刺引流管(8Fr, 12Fr, 14Fr)对高血压脑室出血(Hypertensive ventricular hemorrhage, HVH)患者血肿清除效率、并发症及神经功能预后的影响。方法：将2019年1月至2024年12月三家三级医院收治的215例HVH患者随机分为三组，分别采用8Fr (A组，72例)、12Fr (B组，71例)和14Fr (C组，72例)引流管进行脑室外引流治疗，比较三组术后7天血肿清除率、90天格拉斯哥预后评分(Glasgow outcome scale, GOS)及并发症发生率。结果：B组预后良好率(GOS ≥ 4分)达65.5%，显著优于A组(48.6%)及C组(53.8%) (P = 0.023)；C组血肿清除率(89.2%)显著高于A组(72.3%)和B组(84.5%) (P = 0.003)。C组颅内感染率(18.1%)与再出血率(19.4%)均显著高于A组(5.6%, 8.3%)及B组(11.3%, 12.7%) (P < 0.05)，而A组导管堵塞率(25.0%)显著高于B组(9.9%)和C组(6.9%) (P = 0.001)。结论：12Fr引流管在HVH治疗中展现出最佳临床平衡性，既能有效提升血肿清除效率，又可显著降低并发症风险，是改善患者神经功能预后的优选方案。

Abstract: Objective: To investigate the effects of ventriculostomy drainage tubes with different diameters (8Fr, 12Fr, 14Fr) on hematoma clearance efficiency, complications, and neurological prognosis in patients with hypertensive ventricular hemorrhage (HVH). Methods: A total of 215 HVH patients admitted to three tertiary hospitals from January 2019 to December 2024 were randomly divided into three groups: Group A (8Fr, 72 cases), Group B (12Fr, 71 cases), and Group C (14Fr, 72 cases). The hematoma clearance rate at 7 days postoperatively, 90-day Glasgow Outcome Scale (GOS) scores, and complication rates were compared. Results: Group B achieved the highest good prognosis rate (GOS ≥ 4) of 65.5%, significantly better than Group A (48.6%) and Group C (53.8%) (P = 0.023). The hematoma clearance rate in Group C (89.2%) was significantly higher than in Group A (72.3%) and Group B (84.5%) (P = 0.003). Group C showed significantly higher rates of intracranial infection (18.1%) and rebleeding (19.4%) compared to Group A (5.6%, 8.3%) and Group B (11.3%, 12.7%) (P < 0.05), while Group A had the highest catheter occlusion rate (25.0%) compared to Group B (9.9%) and Group C (6.9%) (P = 0.001). Conclusion: The 12Fr drainage tube demonstrates optimal clinical balance in HVH treatment, effectively improving hematoma clearance efficiency while significantly reducing complication risks, making it the preferred option for enhancing neurological functional prognosis.