CT评价腰大池引流减少蛛网膜下腔出血的研究

CT evaluation of lumbar drainage improving subarachnoid hemorrhage

目的探讨腰大池引流对蛛网膜下腔出血患者的有效性和安全性。方法选择蛛网膜下腔出血患者44例，19例行腰大池引流设为引流组，25例未行脑脊液引流或仅行单独的脑室外引流设为对照组。分析2组患者新发脑梗塞的发生率及引流组的并发症。结果CT影像比较表明，引流组新发脑梗塞的发生率（5％）少于对照组（32％），其差异具有统计学意义（P〈0．05）；脑积水的发生率2组无区别，腰大池引流组并发症很少且可进行良好的控制。结论严格掌握适应症和正确操作，腰大池引流具有较少的并发症和良好的安全性，可有效减少蛛网膜下腔出血患者脑血管痉挛及其相关梗塞。

Objective To analyze the safety and effectiveness of using lumbar drainage （LD） in patients with subarachnoid hemorrhage （SAH）. Methods Data from 44 patients with SAH were collected. Of these patients, the LDs group consisting 19 patients in whom a lumbar drain had been placed for cerebro-spinal fluid （CSF） drainage, whereas the control group was composed of 25 patients who received no form of CSF drainage or treated solely with an external ventricular drainage （EVD）. Incidence of new cerebral infarction of the two groups was measured on sequential CT and complications of LDs group. Results This retrospective review demonstrated a statistically significant beneficial effect in LDs group on CT, reducing the incidence from 32% to 5%. A similar degree of benefit was observed in two group patients with hydrocephalus. Complications with lumbar drains were rare and yielded no permanent sequelae. Conclusion With rare complications and definite safety, LDs are effective to reduce vasospastic cerebral infarction of SAH patients when appropriate patient selection and good technique are employed.