蛛网膜下腔出血后迟发性血管痉挛的临床研究

Clinical study on cerebral vasospasm after subarachnoid hemorrhage

目的探讨地塞米松脑脊液置换术对预防蛛网膜下腔出血(SAH)后迟发性血管痉挛的临床效果。方法 56例SAH患者随机分别两组,对照组患者在发病10 d内,每2 d实施一次脑脊液置换手术,治疗10 d后频率减慢,改为每5 d置换一次,置换液使用4～6 ml生理盐水;研究组患者脑脊液置换方法前4次同对照组,第5次采用事先配备好、且预温达37℃的地塞米松10 ml。结果两组患者术后脑血管痉挛(CVS)发生率,研究组(1.79%)明显低于对照组(8.93%);头痛缓解时间研究组明显低于对照组;两组数据经统计学分析,差异有统计学意义(P<0.05)。结论地塞米松脑脊液置换术能有效预防SAH后迟发性CVS,并加快临床头痛症状的缓解。

Objective To explore the clinical effect of cerebrospinal fluid replacement with dexamethasone in prevention of cerebral vasospasm（CVS） after subarachnoid hernorrhage.Methods Cerebrospinal fluid replacement with 4 to 6 ml of normal saline was carried out in patients of control group once every 2 days for 10 days then changed to once every 5 days.Cerebrospinal fluid replacement with 4 to 6 ml of normal saline was carried out in patients of study group as same as in control group for the first 4 times,then the fluid for replacement changed to 10 ml of dexamethasone solution pre-warmed at 37℃ from the 5th day.Results The incidence of CVS in study group was significantly lower than that of control group,and the duration for relief of headache in study group was significantly shorter than that of control group,and the difference between these two groups was significant（P0.05）.Conclusion The cerebrospinal fluid replacement with dexamethasone can effectively prevent the occurrence of CVS in patients with subarachnoid hemorrhage,and it can speed up the relief of headache.