破裂颅内动脉瘤栓塞治疗后持续腰大池引流的疗效观察

Efficacy and complications of continuous lumbar drainage in coiled ruptured aneurysm

目的探讨持续腰大池脑脊液引流在破裂颅内动脉瘤栓塞治疗后的疗效和并发症防治措施.方法对58例破裂颅内动脉瘤患者在血管内介入栓塞治疗后行持续腰大池引流脑脊液的疗效和并发症进行回顾性分析.结果腰大池引流能明显降低破裂颅内动脉瘤栓塞治疗后患者脑血管痉挛和分流手术依赖性脑积水的发生率（均 P〈0.05）,并改善患者发病后6个月的预后（P〈0.05）;但并未能明显降低患者的病死率（P 〉0.05）.破裂颅内动脉瘤栓塞治疗后持续腰大池引流的并发症主要为导管相关并发症29例（50.0%）和流速相关并发症18例（31.0%）,其中引流不畅10例、过度引流引起的低颅内压综合征5例、颅内感染2例和置管处脑脊液漏6例.结论破裂颅内动脉瘤栓塞治疗后行持续腰大池引流是安全有效的,可用于防治症状性脑血管痉挛和分流依赖性脑积水的发生,改善患者的预后;但需要重点防治脑脊液过快引流导致的低颅内压症状和颅内感染.

Objective To evaluate the efficacy and complications of continuous lumbar drainage of cerebrospinal fluid in patients with aneurysmal subarachnoid hemorrhage treated by intervention coiling. Methods The effects and complications of continuous lumbar drainage of cerebrospinal fluid were retrospectively analyzed in 58 coiled aneurysmal subarachnoid hemor-rhage patients Results Continuous lumbar drainage had beneficial effects to lower the prevalence of vasospasm （P〈0.05） and permanent shunting-depended hydrocephalus （P〈0.05）. It improved outcomes in 6 months （P〈0.05）, but failed to reduce mor-tality of patients （P 〉0.05）. The catheter-related complications took place in 29 cases （50.0%） and flow-related complications in 18 cases （31.0%）, including 10 cases of poor drainage, 5 of low cranio-pressure syndromes, 2 of subarachnoid infection and 6 of CSF leak at the site of lumber puncture. Conclusion Lumbar drainage of cerebrospinal fluid may have beneficial therapeutic ef-fects and improve short term-outcome in coiled aneurysmal subarachnoid hemorrhage.