Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial
Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial
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DOI：
10.3171/jns.2004.100.2.0225
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发表时间：
2004-02-01
影响因子：
4.1
通讯作者：
Spetzler, RF
中科院分区：
文献类型：
--
作者：
Klopfenstein, JD;Kim, LJ;Spetzler, RF
Object.本研究的目的是在一项前瞻性随机试验中比较蛛网膜下腔出血（SAH）患者快速和逐渐脱离脑室外引流的效果。在2001年12月至2002年12月期间，81例植入脑室外引流（EVD）的蛛网膜下腔出血患者入组研究：41例患者随机分配至快速撤机组，40例患者随机分配至逐渐撤机组。两组在年龄、性别、后动脉瘤位置、Fisher分级、Hunt和Hess分级、入院时脑室内出血和入院时脑积水方面匹配良好。快速撤机定义为在24小时内立即关闭EVD进行撤机，而逐渐撤机则在96小时内进行，每天连续升高EVD系统的高度，然后关闭引流管24小时。EVD撤机失败的所有患者均接受了分流管置入。比较了分流管植入率、重症监护室（ICU）天数和总住院时间。快速断奶组（63.4%）和逐渐断奶组（62.5%）的分流管植入率无显著差异。然而，逐渐断奶组的患者在ICU的平均时间多2.8天（p = 0.0002），在医院的平均时间多2.4天（p = 0.0314）。与快速撤机相比，渐进式、多步EVD撤机在预防需要长期分流放置和延长ICU和住院时间方面对蛛网膜下腔出血患者没有优势。
Object. The goal of this study was to compare rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage (SAH) in a prospective, randomized trial.Methods. Between December 2001 and December 2002, 81 patients with aneurysmal SAH in whom external ventricular drains (EVDs) had been placed were enrolled in the study: 41 patients were randomized to the rapidly weaned group and 40 were randomized to the gradually weaned group. The two groups were well matched with respect to age, sex, posterior aneurysm location, Fisher grade, Hunt and Hess grade, intraventricular hemorrhage on admission, and hydrocephalus on admission. Rapid weaning was defined as weaning that occurred within 24 hours with immediate closure of the EVD, whereas gradual weaning took place over a 96-hour period with daily, sequential height elevations of the EVD system followed by drain closure for 24 hours. All patients in whom EVD weaning failed underwent shunt placement. Rates of shunt implantation, days in the intensive care unit (ICU), and overall duration of hospitalization were compared. There was no significant difference in rates of shunt implantation between the rapidly weaned (63.4%) and gradually weaned (62.5%) groups. Nevertheless, patients in the gradually weaned group spent a mean of 2.8 more days in the ICU (p = 0.0002) and 2.4 more days in the hospital (p = 0.0314) than patients in the rapidly weaned group.Conclusions. Compared with rapid weaning, gradual, multistep EVD weaning provided no advantage to patients with aneurysmal SAH in preventing the need for long-term shunt placement and prolonged ICU and hospital stays.