腰椎穿刺引流脑脊液治疗动脉瘤性蛛网膜下腔出血的临床效果分析

Study of clinical effect of lumbar puncture drainage in patients with subarachnoid hemorrhage

目的 探讨持续腰椎穿刺引流脑脊液治疗动脉瘤性蛛网膜下腔出血的临床效果.方法 选择2006年1月至2013年6月入住解放军第一四八医院、郑州大学第二附属医院神经内科的305例动脉瘤性蛛网膜下腔出血患者,按随机数字表将患者随机分为研究组（152例）和对照组（153例）.研究组患者给予标准治疗＋腰椎穿刺引流脑脊液,对照组只进行标准治疗.观察2组迟发性缺血性神经功能缺损的发生率和临床改善情况.结果 研究组和对照组迟发性缺血性神经功能缺损的发生率分别为21.1％ （32/152）和36.6％ （56/153）,组间差异有统计学意义（P=0.018）.研究组患者24 h平均引流脑脊液（135±14）ml,平均引流时间（5.2±1.1）d.研究组局灶性缺血者和意识障碍者占比明显低于对照组[8.5％ （13/152）比20.9％（32/153）,7.2％（11/152）比9.2％ （14/153）]（P=0.015,P=0.036）,脑梗死发生率低于对照组[23.3％（35/152）比31.2％ （48/153）] （P=0.036）,需要持续脑脊液腹腔分流者占比低于对照组[4.6％（7/152）比7.8％ （12/153）] （P =0.024）.在第10天和6个月,研究组改良的Rankin评分0～2分者占比分别为55.3％（84/152）和81.6％（124/152）,而对照组分别为34.6％ （53/153）和80.4％（123/153）,第10天组间差异有统计学意义（P =0.007）.结论 动脉瘤性蛛网膜下腔出血后持续腰椎穿刺引流脑脊液能降低迟发性缺血性神经功能缺损的发生率,改善早期临床结果,但对出血后6个月时的临床结果无明显影响.

Objective To explore the effect of continuous lumbar puncture drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage （aSAH） on delayed ischemic neurological deficit （DIND）.Methods From January 2006 to June 2013,305 patients with aSAH were recruited from the 148 Hospital and the Second Affiliated Hospital of Zhengzhou University.According to World Federation of Neurological Surgeons （WFNS） grade 1 to 3 aSAH and modified Fisher grades 2,3,4,patients were randomly divided into the study group and the control group.The study group was given standard therapy plus lumbar drain and the control group was given standard therapy only.The primary observation was the prevalence of DIND and clinical improvement.Results The prevalence of DIND was 21.1% （32/152） and 36.6% （56/153） in the study group and in control group; there was significant difference of the incidence of delayed ischemic neurological functional defect between two groups （P =0.018）.The average 24 h drainage volume of study group was （135 ± 14）ml and the average drainage time was （5.2 ± 1.1）d.Focal ischemia and the disturbance of consciousness in study group were notably lower than those in the control group[8.5% （13/152） vs 20.9% （32/153）,7.2% （11/152） vs 9.2% （14/153）] （P =0.015,P =0.015） ; the incidence of cerebral infarction was lower than that in the control group [23.3% （35/152） vs 31.2% （48/153）] （P =0.036） ; the proportion of patients who needed continuous cerebrospinal fluid peritoneal shunt was lower than that in the control group[4.6% （7/152） vs 7.8% （12/153）]（P =0.024）.At day 10 and 6 month,a modified Rankin Scale score in the study group was 55.3% （84/152） and 81.6% （124/152） ; it was 34.6% （53/153）and 80.4% （123/153） in the control group.Conclusion Continuous lumbar puncture drainage of cerebrospinal fluid after aSAH can reduce the prevalence of DIND and improve early clinical outcome,but there is no influence at 6 months after aSAH.