腰穿置管脑脊液持续引流治疗蛛网膜下腔出血的临床观察

Persistent Cerebrospinal Fluid Drainage via Lumbar Puncture and Catheter Placement for the Treatment of Subarachnoid Hemorrhage

目的探讨腰穿置管脑脊液持续引流治疗蛛网膜下腔出血(SAH)的临床价值。方法引流组28例在内科常规治疗的基础上,用16号硬膜外穿刺针于L3,4间隙穿刺置入硬膜外导管,接一次性输液管及引流袋,持续引流,引流速度1～4(平均3)滴/min,引流量度100～400(平均250)ml/d。引流3～7(平均5、6)d后拔管。对照组32例仅给内科常规治疗。结果引流组在治疗后第3,5,7天脑脊液中红细胞比对照组明显减少(P<0.05,或0.01)。神经功能缺损评分,引流组为8.76±8.24明显优于对照组的15.0±8.53。临床疗效,引流组基本痊愈率(20/28)明显高于对照组(7/32),而病死率引流组为2/28明显低于对照组的7/32;两组基本痊愈率与病死率比较,差异均较显著(P<0.05)。两组并发症相比,引流组也少于对照组。结论持续腰池脑脊液引流治疗SAH,能改善患者预后,是一种治疗SAH的有效,安全和简便的治疗方法。

Objective To discuss the clinical application of persistent cerebrospinal fluid drainage via lumbar puncture and catheter placement to subarachnoid hemorrhage. Methods In addition to routine treatment, drainage group consisting of 28 patients with subarachnoid hemorrhage (SAH) were placed extradural catheters connected to drainage bags via puncture at the gaps between the third and the fourth lumbar vertebrae so that persistent drainage whose speed was at 1~4 drops/min could be performed. The catheters were pulled out after 3~7 days' drainage, and the amount of drainage was about 100~400 ml/d. Being a contrast to the group mentioned above, control group consisting of 32 patients were only given routine treatment. Results The red blood cells of cerebrospinal fluid of drainage group were fewer than that of control group on the third, fifth and seven day after the beginning of drainage (P<0.05, or P<0.05). The score of neural function defect of drainage group was (8.76±8.24), better than that of control group (15.04±8.53). The basic healing rate of drainage group (20/28) was significantly higher than that of control group (7/32) (P<0.05). There were two patients who died in drainage group while seven ones died in control group, which showed clear difference (P<0.05). Also, the complications were fewer in drainage group than in control group. Conclusion Persistent cerebrospinal fluid drainage via lumbar pool can improve the prognosis of SAH, and is an effective, safe and convenient way to its therapy.