脑室出血后脑脊液中溶血磷脂酸及侧脑室联合腰大池引流对脑积水的防治

Lysophosphatidic acid level of cerebrospinal fluid after intraventricular hemorrhage and external ventricular drainage combined with lumbar cistern drainage for prevention and treatment of hydrocephalus

目的探讨脑室出血(IVH)后脑脊液中溶血磷脂酸(LPA)及侧脑室联合腰大池引流对脑积水的防治效果。方法选取86例IVH患者随机分为两组。对照组患者仅行侧脑室外引流治疗;观察组患者则采用侧脑室联合腰大池外引流治疗,并定期测定两组患者脑脊液中LPA含量,观察其与IVH后脑积水的关系及临床安全性。结果 IVH后患者脑脊液的血液清除时间观察组明显短于对照组(t=4.893,P=0.006);对照组患者发病7和14 d时脑脊液LPA含量显著高于观察组(t1=3.118,P=0.002;t2=2.910,P=0.036);对照组慢性脑积水的发生率明显高于观察组(χ2=4.807,P=0.028);所有IVH并发脑积水患者发病14 d时脑脊液中LPA含量显著高于IVH后未并发脑积水患者(t=6.056,P=0.000);治疗期间两组患者均未出现严重并发症。结论侧脑室联合腰大池外引流较单纯侧脑室外引流能够更有效防治IVH后脑积水的发生,这与其迅速降低IVH后脑脊液中LPA含量密切相关。

[Objective] To investigate lysophosphatidic acid （LPA） level of cerebrospinal fluid （CSF） after intraventricular hemorrhage （IVH） and external ventricular drainage combined with lumbar cistern drainage for the prevention and treatment of hydrocephalus. [Methods] A total of B6 patients with IYH admitted to the 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 accepted external ventricular drainage combined with lumbar cistern drainage and those in the control group only had external ventricular drainage. And the level of LPA in CSF of the patients of both groups was regularly measured. The relationship between the occur- rence of chronic hydrocephalus after IVH and the level of LPA in CSF was analyzed. The safety was ob- served. [Results] The blood clearance time of cerebrospinal fluid in the observation group was significantly shorter than that in the control group （t= 4.893, P= 0.006）. On the day 7 and 14 after IVH, the level of LPA in the control group was significantly higher than that in the observation group （t1 = 3.118, P= 0.002; t2 = 2.910, P=0.036）. In the observation group the incidence of chronic hydrocephalus was significantly lower than that in the control group （X2=4.807, P=0.028）. On the day 14 after IVH, the level of LPA in the patients with hydrocephalus was significantly higher than that in the patients without hydrocephalus （t1=6.056, P = 0.000）. No obvious adverse reaction was found in either group. [Conclusion] External ventricular drainage combined with lumbar cistern drainage can effectively prevent the occurrence of chronic hydrocephalus after IVH. Its mechanism is closely related to the reduced content of LPA in CSF after IVH.