密闭式腰池循环引流置换脑脊液治疗重度蛛网膜下腔出血的临床研究

Clinical study of treatment of severe subarachnoid hemorrhage with closed lumbar pool circulation drainage replacement of cerebrospinal fluid

目的探讨研究密闭式腰池循环引流与置换脑脊液(CSF)治疗重度蛛网膜下腔出血(SAH)的临床价值。方法将298例重度SAH患者随机(投掷硬币法)分为治疗组(采用腰池置管密闭式循环引流置换CSF治疗,146例)和对照组(采用间断腰穿CSF置换治疗,152例)。分析比较两组病例的疗效。结果治疗组美国国立卫生研究院卒中量表评分(NIHSS)为(6.34±5.15)分、Barthel日常生活活动(ADL)指数评分(91.39±15.32)分、GCS(13.98±1.04)分;对照组NIHSS(15.91±7.26)分、ADL指数评分(53.86±13.39)分、GCS(10.05±1.46)分;两组均差异明显(P<0.01)。治疗组患者头痛持续时间(6±2.63)d、SAH廓清时间(4±1.7)d、住院(23±3.1)d。并发症的发生率35.62%、死亡率13.01%,均分别低于对照组的(15±1.72)d、(11±2.6)d、(39±3.7)d、55.92%和25.66%(P<0.05)。结论腰池置管密闭式循环引流与置换CS术治疗重度SAH简便易行、经济安全、疗效确切。

Objective To investigate the clinical value of closed lumbar pool circulation drainage replacement （CLPCDR） of cerebrospinal fluid （CSF） for severe subarachnoid hemorrhage （SAH）. Methods Two hundred ninety-eight patients with severe SAH were randomly divided into two groups, i.e. treatment group （n=146, treated with CLPCDR of CSF） and control group （n=152, treated with intermittent replacement of CSF）. The curative effects were compared between both the groups. Results National Institute of Health stroke scale （NIHSS）, Barthel activity of daily living index and GCS in the treatment group were （6.34±5.15）, （91.39±15.32） and （13.98±1.04） points respectively, and they in the control group were （15.91±7.26）, （53.86±13.39） and （10.05±1.46） points respectively. There were significant differences in them between both the groups （P〈0.01）. The incidence of the complications, including cerebral vasospasm in 15 cases, hydrocephalus in 28 cases, intracranial rebleeding in 8 cases and intracranial infection in 1 case, was 35.62% （52/146）, and the death rate was 13.01%（19/46） in the treatment group. The incidence of the complications, including cerebral vasospasm in 24 cases, hydrocephalus in 45 cases, intracranial rebleeding in 13 cases and intracranial infection in 3 cases was 55.92%（85/152）, and the death rate was 25.66% （39/152） in the control group. The durations of headache, time from hemorrhage to clearing up SAH and length of hospital stay were （6±2.63）, （4±1.7） and （23±3.1） days in the treatment group, and （15±1.72）, （11±2.6） and （39±3.7） days respectively in the control group. There were significant differences in them between both the groups （P〈0.05）. Conclusion The CLPCDR of CSF is a simple, safe and effective method to treat severe SAH.