Single versus bilateral external ventricular drainage for intraventricular fibrinolysis using urokinase in severe ventricular haemorrhage

doi:10.3969/j.issn.1002-1949.2014.04.008

Abstract：Objective To compare the drainage efficiency in single or bilateral external ventricular drainage ( EVD ) under the intraventricular fibrinolysis ( IVF ) of urokinase in severe ventricular haemorrhage cases .Methods Forty seven patients with severe ventricular haemorrhage were came from Emergency Department and Neurosurgery Department , Shenzhen People's Hospital from January 2010 to June 2013 .The patients were divided into two groups: the single EVD group and the bilateral EVD group .Each patient accepted the same IVF therapy with urokinase 20000Uq 12h.The two groups were measured the average daily volume of CSF , intracranial pressure ( ICP) , GCS and ICU monitoring time, IVC placement time, IVH volume, Graeb scores, the rate of intracranial infection, etc before IVF and 1, 3, 5, 7 days after IVF.Statistical comparisons between groups were analyzed by using repeated measurement design analysis of variance and Student 's T test.The death rate and GOS score were recorded and compared in the six months after attacks .Results There were no statistically significant differences between the two groups with baseline IVH volume , initial Graeb score, GCS, age and gender .The ICU monitoring time and IVC placement time in two groups showed no statistical difference (P >0.05), the average daily CSF drainage were statistically significant different (P <0.05 ) , the bilateral EVD group average daily CSF was more than the single EVD group .The IVH volume decreased more significantly in the two groups , the bilateral EVD group was decreased more than the single EVD group (P<0.05) before and after IVF at 1, 3, 5, 7 days.However, the Graeb scores, ICP, GCS between the two groups showed no significant difference (P>0.05).The two groups during drainage were not found intracranial infection .Bilateral EVD group was significant better than single EVD group when comparing GOS score (t=12.63, P=0.000) and death rate (χ2 =7.57, P=0.006) in the six months .Conclusion Under the same conditions of IVF , the hematoma removal efficiency with bilateral EVD is higher than the single EVD in the serious , large volume of IVH patients and bilateral EVD can improve the prognosis and reduce death rate .At same time it does not increase intracranial infection rate and prolong the IVC placement time and ICU monitoring time .