持续腰穿引流治疗蛛网膜下腔出血致脑血管痉挛

Continuous lumbar drainage for treatment of Cerebral Vasospasm induced by subarachnoid hemorrhage

目的探讨持续腰穿引流术对蛛网膜下腔出血(SAH)致脑血管痉挛(CVS)的治疗作用。方法SAH患者60例,随机分为研究组(予持续腰穿引流)和对照组(予常规腰穿)。治疗过程中动态观察2 d、3 d、7 d的颅内压;经颅多普勒观察局部脑血流变化和CVS持续时间;临床观察主要症状(发热、头痛、颈强直)持续时间。在治疗前后对患者行Hunt评分评价治疗结果。结果研究组治疗3 d后即较对照组的颅内压降低(P<0.05),CVS和临床主要症状持续时间短于对照组。治疗7 d后Hunt评分研究组较对照组明显降低(P<0.05)。6个月随访结果,研究组病死率3%,对照组13%;脑积水、颅内感染发生研究组少于对照组。结论持续腰穿引流术能明显减轻SAH致急性CVS的程度,利于神经功能的恢复。

Objective It is to approach the therapeutic action of continuous lumbar drainage on cerebral vasospasm （CVS） induced by subarachnoid hemorrhage （ SAH）. Methods 60 SAH patients were randomly divided into study group in which the patients were treated with continuous lumbar drainage and control group in which the patients were treated with conventional lumbar drainage. All patients were given dynamic observation of measurement of intracranial pressure （ICP） , head TCD examination local blood flow of brain, the duration of CVS and the major symptoms （fever, headache, neck stiffness） with results recorded on the 2nd, 3rd and 7th day of the treatment. In addition, the Hunt grade was given to both groups before and after the treatment. Results After three days of treatment, ICP in study group was lowered than that in control group （ P 〈 0.05） , the duration of CVS and main symptoms were shorter than that in control group. After seven days of treatment, Hunt grade in study group was obviously lower than that in control group （ P 〈 0.05 ）. Six-month follow-up results showed that of the mortality rate in study group was 3% and that in control group was 13% , and hydrocephalus, intracranial infection in study group occurred less than that in control group. Conclusion Continuous lumbar drainage can obviously lighten the degree of CVS induced by SAH, which is helpful for the recovery of brain function.