蛛网膜下腔出血脑脊液引流并置换的治疗时机与方式选择

The opportunity and style of equipped with closed waist pool circulation drainage replacement of cerebrospinal fluid for subarachnoid hemorrhage

目的探讨研究蛛网膜下腔出血(SAH)早期行脑脊液引流与置换术的时机和方式,观察其临床效果。方法共入选重度原发性SAH患者43例,根据入院先后随机分为治疗组(采用腰池置管密闭式循环引流与置换CSF技术治疗)21例和对照组(采用间断腰穿CSF置换术治疗)22例。另选择同期住院的轻-中度SAH患者23例作为空白组(单纯内科保守治疗)。观察指标为神经功能缺损评分(NIHSS)、日常生活活动能力评分(ADL)、意识障碍评分(GCS)、头痛缓解时间、蛛网膜下腔血液廓清时间、住院时间、病死率及并发症。结果治疗组NIHSS 5.85±5.35、ADL 95.42±16.35、GCS 13.95±1.03;对照组NIHSS 20.83±8.78、ADL 63.23±10.45、GCS 9.80±1.47。两组比较差异均有统计学意义(P<0.01);治疗组并发脑积水、脑血管痉挛发生率为23.81%(5/21),死亡2例(9.5%),低于对照组的54.54%(12/22),死亡4例(18.2%),差异有统计学意义(P<0.05);治疗组患者头痛缓解时间5±1.38d、蛛网膜下腔血液廓清时间3±1.6d、住院时间17±1.8d,低于对照组的16±2.57d、8±2.5d及33±1.5d,差异有统计学意义(P<0.01)。三组再出血的发生率分别为14.29%(3/21)、18.18%(4/22)及21.74%(5/23),差异无统计学意义(P>0.05)。结论根据SAH的轻重程度早期选择不同的CSF引流与置换技术能提高治愈率,降低病死率和致残率,减少症状性脑血管痉挛和慢性脑积水的发生率,缩短住院时间,无增加再出血的风险,提高患者的生活质量。

Objective To investigate the opportunity and style of equipped with closed waist pool circulation drainage replacement of cerebrospinal fluid for primarily subarachnoid hemorrhage（SAH）.Methods 43 patients with severe primarily SAH were randomly divided into two groups：treatment group（n=21,treated with closed waist pool circulation drainage replacement of cerebrospinal fluid）,control group（n=22,treated with intermittent replacement of cerebrospinal fluid）,and blank group（23 patients with light-midrange SAH were treated with merely medicine expectant treatment）.The observation tagets were National Institutes of Health Stroke Scale（NIHSS）,activities of daily living（ADL）,Glasgow Coma Scale（GCS）,time of headache to relieve,time of subarachnoid blood to clear up,days in hospital,mortality rate and complication.Results After the treatment,NIHSS,ADL and GCS in the treatment group were 5.85±5.35,95.42±16.35,13.95±1.03,and those in the control group were 20.83±8.78,63.23±10.45,9.80±1.47 respectively.There were significant differences in them between both groups（P0.01）.In the treatment group,incidence of cerebral vasospasm hydrocephalus was 23.81%（5/21）and 2 cases（9.5%）death,which was lower than that of 54.54%（12/22）and 4 cases（18.2%）death in the control group.There were also significant differences in them（P0.05）.The time of Headache to relieve（5±1.38d）,time of subarachnoid blood to clear up（3±1.6d）,days in hospital（17±1.8d）in treatment group,lower than those of the control group（16±2.57d,8±2.5d,33±1.5d）.There were significant differences in them between both the groups（P0.01）.Incidence rate of rehaemorrhagia in the three groups were 14.29%（3/21）,18.18%（4/22）,21.74%（5/23）respectively,there were no significant differences（P0.05）.Conclusion The closed drainage and displacement of CSF through terminal cistern are the simple,safe and effective methods to treat SAH,can reduce incidence rates of cerebral angio spasm and chronic hydrocephalus.and improve patients＇ living ability.Don＇t increase the risk of rehaemorrhagia.