脑脊液置换术治疗蛛网膜下出血160例疗效观察

Observation the Therapeutic Effect of 160 Cases with Cerebrospinal Fluid（CSF） Replacement on Subarachnoid Hemorrhage （SAH）

目的观察脑脊液置换术治疗蛛网膜下腔出血（以下简称SAH）的疗效。方法诊断成立后即行脑脊液置换术隔日1次，共置换p5次，每次腰穿放出血性脑脊液5～10ml，以等量生理盐水进行缓慢置换，间隔5min再放出血性脑脊液5～10ml。以等量生理盐水进行置换，再问隔5min放出血性脑脊液5～10ml，以等量生理盐水进行置换，加地塞米松5mg鞘内注射。结果160例经置换脑脊液后头痛能迅速缓解，平均为4．6d，而对照组150例头痛缓解时间平均为13．2d，P〉0．05。脑血管痉挛致脑梗死的发生，置换组0例，而对照20例，置换组无脑积水的病例发生。而对照组发生脑积水25例。结论应用脑脊液置换术治疗SAH是一种缓解头痛，减少脑血管痉挛、梗阻性脑积水的有效方法。

Objective To observe the therapeutic effect of cerebrospinal fluid （CSF） replacement on subarachnoid hemorrhage （SAH）.Methods The therapy of cerebruspinal fluid replacemem was performed to patients with SAH every other day for 3-5 times. 5-10 ml bloody cerebralspinal fluid （BCSF） was exchanged with the equivalent valume of normal saline by lumber puncture, and repeated the procedure for 3-5 times. After that ,5 mg dexamethasone was gived by intrathecal injection. Results The symptom of cephalalgia of the 160 cases were relieved rapidly in average 4.6 days by the therapy. By contrast, there was a significant difference between treatment and control group （average 13.2 days） on the remission time, P〉O.05. Cerebral vasospasm which cause the occurrence of cerebral infarction were also obviously different between treatment （0 case） and control group（20 case） respectively. None of hydrocephaloid occurred in the treatment group,and 25 case in control group. Conclusions Application of cerebrospinal fluid replacement therapy was effective to relieving headaches, reduce cerebral vasospasm, obstructive hydrocephalus for patients with SAH.