动脉瘤破裂夹闭术后腰大池引流对蛛网膜下腔出血的治疗

Treatment of subarachnoid hemorrhage by lumbar cerebrospinal fluid drainage post aneurysm clipping

目的探讨持续腰大池脑脊液引流并早期动脉瘤夹闭术治疗蛛网膜下腔出血(SAH)的临床价值。方法将122例SAH患者随机分成治疗组和对照组,两组均给予常规药物治疗和早期动脉瘤夹闭术,同时64例治疗组在麻醉后即给予持续腰大池脑脊液引流。58例对照组则在术后给予反复多次腰椎穿刺释放脑脊液。比较两组脑脊液中红细胞数变化及术后脑血管痉挛程度、脑积水并发症、GOS分级评定疗效。结果治疗组在清除蛛网膜下腔出血、减轻脑血管痉挛和脑积水发生率、治疗结果等方面均明显优于对照组,腰大池引流相关并发症极少。结论持续腰大池脑脊液引流并早期动脉瘤夹闭术治疗蛛网膜下腔出血安全、有效,适宜推广应用。

Objective The clinical value of continuous lumbar cerebrospinal fluid drainage （CLCFD） and early aneurysm clipping in treatment of subarachnoid hemorrhage （SAH） are investigated. Methods A total of 122 SAH patients who accepted routine treatment and early aneurysm clipping were divided into treatment group and control group. CI.EFD was applied i^ately after general anesthesia in 64 patients in the treatment group. In the control group bloody cerebrospinal fluid was drained by lumber puncture in 58 patients after the operation. The changes of red blood cells in cerebrospinal fluid, the post-operative cerebral vasespasm and hydrocephalus and GOS were compared to evaluate the clinical results. Results The removal of subarachnoid hemorrhage, the alleviation of the cerebral vasespasm, the hydrocephalus rate and the clinical outcome were better in treatment group compared with the control group. There was no related-CLCFD complication. Conclusion CLCFD and early aneurysm clipping is effective and safe for the treatment of subarachnoid hemorrhage.