脑脊液置换术联合鞘内注射治疗创伤性蛛网膜下腔出血临床研究

The effect of different amount exchange of cerebrospinal fluid combining with small dose of urokinase intrathecal injection and dexamethasone for traumatic subarachnoid hemorrhage

目的观察早期不等量脑脊液置换术联合尿激酶及地塞米松鞘内注射治疗创伤性蛛网膜下腔出血(tSAH)的临床疗效及安全性。方法将76例诊断明确的tSAH患者分为治疗组39例,对照组37例。治疗组行腰椎穿刺不等量脑脊液置换联合鞘内注射尿激酶及地塞米松,置换总量每次35～50mL;对照组行常规腰椎穿刺测压及脑脊液常规生化检查,未行脑脊液置换。观察指标:主要临床症状、体征恢复情况,脑脊液血红蛋白(Hb)清除时间,颅内压恢复时间,并发症发生率,治疗效果评价及平均住院时间等。结果治疗组主要临床症状及体征恢复时间明显快于对照组(P<0.01),脑脊液Hb清除时间及颅内压恢复时间明显快于对照组(P<0.01)。治疗组并发脑血管痉挛(7.69%)、脑积水(12.8%)发生率较对照组(分别为32.43%、37.84%)明显降低(P<0.01)。再出血发生率两组无明显差异;治疗组总有效率(92.31%)较对照组(70.27%)明显提高;治疗组平均住院时间(8.56d)较对照组(15.38d)明显缩短(P<0.01)。结论早期不等量脑脊液置换加小剂量尿激酶及地塞米松鞘内注射治疗tSAH安全、有效,能较快改善临床症状,并能有效预防脑血管痉挛及脑积水等并发症的发生,缩短住院时间,减低致残率。

Objective To explore the curative effects of different amount exchange of cerebrospinal fluid combining with small dose of urokinase and dexamethasone intrathecal injection early for the treatment of traumatic subarachnoid hemorrhage（tSAH）. Methods Seventy-six tSAH patients diagnosed by CT and lumbar puncture were randomly divided into two groups..39 patients in the treatment group were given different amount exchange of cerebrospinal fluid combining with small dose of urokinase and dexamethasone injection;37 patients in the control group were treated without exchange of cerebrospinal fluid. The principal clinical symptom and signs recovery time, H bg clear time, intracranial pressure （ICP）recovery time, the main complications, curative effect and length of stay of the two groups were compared. Results The principal clinical symptom and signs recovery time was shorten in the treatment group more than that in the control group（P〈0.01）, Hbg clear time and intracranial pressure recovery time was signifi- cantly faster in treatment group（P〈0.01） complications about cerebral angiospasm and hydrocephalus were fewer than those in the conventional therapeutic group（P〈0.01）,and there were no significant difference in the incidence of rebleeding between the two groups. There were obvious difference about the curative effect and length of stay in the two groups（P〈0.01）. Conclusion The different amount exchange of cerebrospinal fluid combining with small dose of urokinase and dexamethasone injection early is an safe and effective method to treat tSAH. About which therapeatics it can shorten length of stay,improve the survival rate and quality of life of tSAH patients.