密闭式腰池引流微泵置换脑脊液治疗外伤性蛛网膜下腔出血54例疗效观察

Clinical observation on closed drainage and displacement of CSF through terminal cistern in the treatment of 54 cases of traumatic subarachnoid hemorrhage

目的探讨密闭式腰池循环引流微泵置换脑脊液治疗重度外伤性蛛网膜下腔出血的治疗效果。方法治疗组54例采用腰池置管密闭式循环引流微泵置换脑脊液技术治疗,对照组56例采用间断腰穿脑脊液置换术治疗。对两组病例进行对比分析。结果治疗组并发脑积水、脑血管痉挛发生率为14.81%(8/54),死亡6例(11.11%),低于对照组的32.14%(18/56),死亡11例(19.64%),差异有统计学意义(P<0.05)。治疗组患者头痛缓解时间(5±1.33)d、蛛网膜下腔血液廓清时间(3±1.5)d、CSF-RBC2d下降(8.6±11.8)×108/L,低于对照组的(15±1.13)d、(10±2.8)d、(28±23.5)×108/L,差异有统计学意义(P<0.01)。结论腰池置管密闭式循环引流微泵置换脑脊液技术治疗重度外伤性蛛网膜下腔出血疗效确切。

Objective To investigate the effect of closed drainage and displacement of CSF through terminal cistern in the treatment of severe traumatic subaraehnoid hemorrhage （tSAH）. Methods One hundred and ten pa- tients with severe tSAH were randomly divided into two groups： the study group （n=54, treated with closed drainage and displacement of CSF through terminal cistern）, and the control group （n=56, treated with intermittent replacement of cerebrospinal fluid）. The clinical effect was compared between the two groups. Results After treatment, the inci- dence of hydrocephalus and cerebral vasospasm, the mortality rate in the study group were 14.81% （8/54） and 11.11% （6/54）, significantly lower than those in the control group （P〈0.05）, 32.14% （18/56） and 19.64% （11/56）, re- spectively. The time of headache to relieve, time of subarachnoid blood to clear up, the decrease of CSF-RBC in two days were （5~1.33） d, （3x1.5） d, （8.6x11.8）X10^8in the study group, significantly lower than those in the control group （P〈0.05）, （15x1.13） d, （10x2.8） d, （28x23.5）x X10^8, respectively. Conclusion The closed drainage and displacement of CSF throueh terminal cistern is an effective method to treat tSAH.