Department of Neurological Surgery, Columbia University Medical Center, New York, New York.
J Neurosurg. 2014 Apr;120(4):931-6. doi: 10.3171/2013.12.JNS131685. Epub 2014 Jan 10.
Ventriculostomy--the placement of an external ventricular drain (EVD)--is a common procedure performed in patients with acute neurological injury. Although generally considered a low-risk intervention, recent studies have cited higher rates of hemorrhagic complications than those previously reported. The authors sought to determine the rate of postventriculostomy hemorrhage in a cohort of patients with intracerebral hemorrhage (ICH) and to identify predictors of hemorrhagic complications of EVD placement.
Patients with ICH who underwent EVD placement and had both pre- and postprocedural imaging available for analysis were included in this study. Relevant data were prospectively collected for each patient who satisfied inclusion criteria. Variables with a p < 0.20 on univariate analyses were included in a stepwise logistic regression model to identify predictors of postventriculostomy hemorrhage.
Sixty-nine patients were eligible for this analysis. Postventriculostomy hemorrhage occurred in 31.9% of patients. Among all patients with intraparenchymal hemorrhage, the mean hemorrhage volume was 0.66 ± 1.06 cm(3). Stratified according to ventricular catheter diameter, patients treated with smaller-diameter catheters had a significantly greater mean hemorrhage volume than patients treated with larger-diameter catheters (0.84 ± 1.2 cm(3) vs 0.14 ± 0.12 cm(3), p = 0.049). Postventriculostomy hemorrhage was clinically significant in only 1 patient (1.4%). Overall, postventriculostomy hemorrhage was not associated with functional outcome or mortality at either discharge or 90 days. In the multivariate model, an age > 75 years was the only independent predictor of EVD-associated hemorrhage.
Advanced age is predictive of EVD-related hemorrhage in patients with ICH. While postventriculostomy hemorrhage is common, it appears to be of minor clinical significance in the majority of patients.
脑室引流术（EVD）是一种将外部脑室引流管放置于急性神经损伤患者颅内的常见操作。尽管通常认为该操作风险较低，但近期研究报道其出血并发症发生率高于既往报道。本研究旨在确定脑出血（ICH）患者脑室引流术后出血的发生率，并确定 EVD 置管后出血并发症的预测因素。
本研究纳入了行 EVD 置管且术前、术后均有影像学资料可供分析的 ICH 患者。对符合纳入标准的每位患者均前瞻性收集相关数据。单因素分析中 p < 0.20 的变量纳入逐步逻辑回归模型以确定脑室引流术后出血的预测因素。
本研究共纳入 69 例患者。31.9%的患者发生脑室引流术后出血。所有脑实质内出血患者的平均出血量为 0.66 ± 1.06 cm3。根据脑室引流管直径分层，接受小直径引流管治疗的患者平均出血量明显大于接受大直径引流管治疗的患者（0.84 ± 1.2 cm3 vs 0.14 ± 0.12 cm3，p = 0.049）。仅 1 例（1.4%）患者的脑室引流术后出血具有临床意义。总体而言，脑室引流术后出血与出院时或 90 天时的功能结局或死亡率均无相关性。多变量模型中，年龄 > 75 岁是 EVD 相关出血的唯一独立预测因素。
高龄是 ICH 患者 EVD 相关出血的预测因素。尽管脑室引流术后出血较为常见，但在大多数患者中似乎具有较小的临床意义。
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