动脉瘤性蛛网膜下腔出血并脑积水的防治研究

Prevention and treatment of aneurysmal subarachnoid hemorrhage combined with hydrocephalus

目的探讨腰大池置管持续引流对动脉瘤性蛛网膜下腔出血(a SAH)并发脑积水的防治效果。方法选取86例a SAH急性期行动脉瘤夹闭手术患者随机分为两组:对照组患者术后仅行间断腰椎穿刺治疗,观察组患者则术后则行腰大池置管持续外引流治疗,并定期测定两组患者脑脊液中溶血磷脂酸(LPA)含量,观察其与a SAH并发脑积水的关系及临床安全性。结果 a SAH对照组患者发病7 d、14 d时脑脊液LPA含量显著高于观察组(t1=8.225,P=0.000;t2=4.168,P<0.001);a SAH对照组并发急性脑积水的发生率与观察组间无显著性差异(χ2=0.192,P=0.661),而a SAH对照组并发亚急性和慢性脑积水的发生率明显高于观察组(χ2=7.535,P=0.006);所有a SAH并发脑积水患者发病14 d时脑脊液中LPA含量显著高于a SAH未并发脑积水患者(t=4.893,P<0.001);治疗期间两组a SAH患者均未出现严重并发症。结论早期腰大池持续外引流能够有效防治a SAH并发脑积水的发生,该作用与其降低a SAH后脑脊液中LPA含量密切相关。

Objective The prevention and therapeutic effects of early use of continuous lumbar cistern drainage on hydrocephalus after aneurysmal subarachnoid hemorrhage（ aSAH） are discussed. Methods A total of 86 patients with aSAH at acute stage who underwent clipping admitted to People＇s Hospital of Zhengzhou University were randomly divided into control group（ n = 43） and observation group（ n = 43）. The patients in the observation group were performed the continuous lumbar cistern drainage and intermittent lumbar puncture drainage in the control group after clipping. And the levels of lysophosphaditic acid（ LPA） in cerebrospinal fluid（ CSF） of patients within two groups were measured. The relationship between LPA and the occurrence of hydrocephalus after aSAH was observed and the safety in clinical practice was evaluated. Results At 7 d and 14 d after aSAH,the level of LPA of the control group was significantly higher than that of the observation group（ t1=8. 225,P =0. 000; t2=4. 168,P〈0. 001）; there is no significant difference in the incidence of acute hydrocephalus between the observation and control groups（ χ^2=0. 192,P =0. 661）; the incidence of subacute and chronic hydrocephalus in observation group was significantly lower than that in the control group（ χ^2= 7. 535,P = 0. 006）; at 14 d after aSAH,the level of LPA in the patients with hydrocephalus was significantly higher than that without hydrocephalus（ t = 4. 893,P〈0. 000）. No obvious adverse reaction was found in the patients of two groups. Conclusion Early continuous lumbar cistern drainage can be effective for the prevention and treatment of the incidence of hydrocephalus after aSAH,which is closely related to the decrease of LPA in CSF after aSAH.