不同引流速度对蛛网膜下腔出血患者神经功能、炎性应激及血管功能的影响

Influence of cerebrospinal fluid drainage speed on neural function and inflammatory stress and blood vessel function in patients with subarachnoid hemorrhage

目的：探讨不同脑脊液引流速度对蛛网膜下腔出血患者神经功能、炎性应激及血管功能的影响。方法 ：选择2011年1月~2013年12月90例蛛网膜下腔出血患者为研究对象,将90例患者按照随机数字表法随机分为Ⅰ组、Ⅱ组、Ⅲ组,各30例。I组术中采用5mL/h的脑脊液引流速度,Ⅱ组术中采用10mL/h的脑脊液引流速度,Ⅲ组术中采用15mL/h的脑脊液引流速度。检测治疗前及治疗后1、3d血清内皮素-1（ET-1）、可溶性细胞间黏附分子-1（sICAM-1）、C反应蛋白（CRP）、肿瘤坏死因子（TNF-α）、基质金属蛋白酶（MMPs）及热休克蛋白（HSPs）等指标。结果：治疗后1、3d10mL/h组血清ET-1、sICAM-1、CRP、TNF-α水平明显低于同期5mL/h组和15mL/h组,差异有统计学意义（P〈0.05）;治疗后1、3d10mL/h组血清MMP-2、MMP-3、MMP-9水平明显低于同期5mL/h组和15mL/h组,差异有统计学意义（P〈0.05）;治疗后1、3d10mL/h组血清HSP-60、HSP-70、HSP-90水平明显低于同期5mL/h组和15mL/h组,差异有统计学意义（P〈0.05）。结论：蛛网膜下腔出血时采用10mL/h的脑脊液引流速度,可以有效改善患者神经功能、炎性应激反应及血管功能,进而有效改善患者病情和预后。

Objective： To study influence of cerebrospinal fluid drainage speed on neural function and inflammatory stress and blood vessel function in patients with subaraehnoid hemorrhage. Methods： Between January 2011 and December 2013, 90 patients with subarachnoid hemorrhage were selected as the research object, and according to random number table method 90 patients were randomly divided into group Ⅰ,Ⅱ,Ⅲ group with 30 cases in each group. Patients in Group Ⅰ had in- traoperatie cerebrospinal fluid drainage at 5 mL/h; Group Ⅱ had intraoperative cerebrospinal fluid drainage at 10 mL/h; Group Ⅲ had intraoperative using eerebrospinal fluid drainage with a velocity of 15 mL/h. Before and 1 day and 3 days after treat- ment, serum HSPs, MMPs, ET1, sICAM-1, CRP and TNF alpha were tested. Results： After 1 day, 3 days after treatmentserum levels of ET - 1, slCAM 1, CRP, TNF alpha level in 10 mL/h group were significantly lower than 5 mL/h and 15 mL/ h group, the difference was statistically significant （P〈0.05）; Treatment after 1 day, 3 days after treatment, serum levels of MMP- 2 and MMP - 3, MMP - 9 level in 10 mL/h group were significantly lower than 5 mL/h and 15 mL/h group （P〈0.05） ;After 1 day, 3 days after treatment serum HSP 60, HSP - 70, HSP - 90 level in 10 mL/h group were significantly lower than 5 mL/h and 15 mL/h group （P%0.05）. Conclusions：Cerebrospinal fluid drainage at 10 mL/hcan effectively improve nerve function, inflammatory stress response and blood vessel function, and can effectively improve patients condition and prognosis.