颅内压控制下持续腰大池引流治疗外伤性蛛网膜下腔出血

Treatment of traumatic subarachnoid hemorrhage through lumbar subarachnoid continuous drainage under controlling intracranial pressure

目的 探讨颅内压控制下持续腰大池引流对蛛网膜下腔出血的治疗效果。方法 19例外伤性蛛网膜下腔出血(traumatic subarachnoid hemorrhage,t-SAH)患者作为治疗组,实行颅内压控制下持续腰大池引流置换脑脊液,同时对16例患者采用腰穿引流脑脊液作为对照组,通过观察蛛网膜下腔积血的清除时间及脑脊液生化检测蛋白变化情况,头痛缓解时间、再出血、脑积水等并发症的例数及治疗结果判断两者之间的差别。结果 蛛网膜下腔积血清除时间治疗组比对照组快(P<0.05);脑脊液蛋白正常时间治疗组比对照组快(P<0.05);头痛缓解时间治疗组比对照组快(P<0.05);并发症的发生率及患者的治疗结果两组无明显区别(P>0.05)。结论 采用颅内压控制下持续腰大池引流脑脊液治疗外伤性蛛网膜下腔出血疗效优于腰穿脑脊液置换术。

Objective To study the clinical effects of treating traumatic subarachnoid hemorrhage by lumbar subarachnoid continuous drainage under controlling intracranial pressure. Methods 35 cases of traumatic subarachnoid hemorrhage were divided randomly into treatment group (19 cases) and control group (16 cases). Besides the conventional treatment for cerebral injury, the treatment group received lumbar subarachnoid continuous drainage under controlling intracranial pressure, while the control group underwent cerebrospinal fluid (CSF) drainage by lumbar puncture. The treatment effects between two groups were estimated and compared by detecting time of clearing subarachnoid hematoma, change of albumen in CSF, time of headache relief, incidence of complications such as rehemorrhage and hydrocephalus and prognosis. Results The times of cleating subarachnoid hematoma, CSF protein level recovery and headache relief are all shorter in treatment group than in control group (P<0.05); Complication incidence rate and prognosis are almost same in the two groups. Conclusion It is better to treat the traumatic subarachnoid hemorrhage through lumbar subarachnoid continuous drainage under controlling intracranial pressure than CSF drainage by lumbar puncture.