腰大池持续引流治疗创伤性蛛网膜下腔出血的临床分析

Clinical analysis of lumbar continuous drainage treatment for traumatic subarachnoid hemorrhage

目的探讨腰大池持续引流对创伤性蛛网膜下腔出血(t SAH)患者局部脑代谢、认知功能障碍及临床预后的影响。方法 57例t SAH患者随机分为两组,(1)常规治疗组:28例,给予常规治疗;(2)腰大池引流组:29例,自伤后第3 d起在常规治疗的基础上给予腰大池持续引流处理。另设10例交通事故外伤患者(头颅CT检查未见脑挫裂伤及脑出血)为对照组。3组患者分别于伤后第10 d和治疗后3个月门诊随访时行磁共振波谱(MRS)检查、临床痴呆量表(CDR)评分,且常规治疗组和腰大池引流组患者于治疗后3个月门诊随访时行格拉斯哥预后量表(GOS)评分。结果伤后第10 d,与常规治疗组比较腰大池引流组的MRS NAA/Cr、NAA/Cho增高,Cho/Cr降低,差异有统计学意义(均P<0.05)。治疗后3个月,与常规治疗组比较腰大池引流组的CDR评分减低,GOS评分高,差异有统计学意义(均P<0.05)。结论腰大池持续引流能改善t SAH患者的局部脑组织代谢及认知功能,改善患者的预后。

Objective To explore the effect of lumbar continuous drainage on regional cerebral metabolism,cognitive dysfunction and clinical outcomes in patients with traumatic subarachnoid hemorrhage（ t SAH）. Methods 57 patients with t SAH were randomly divided into two groups,28 were in conventional treatment group and 29 in conventional treatment and lumbar continuous drainage（ LCD） group（ lumbar drainage group）. Another 10 cases of traffic accident injury patients（ without brain contusion and hemorrhage on CT） were in control group. Three groups of patients accepted magnetic resonance spectroscopy（ MRS） examination and clinical dementia scale（ CDR） on 10 th day after traumatic brain injury and clinical follow-up after treatment for 3 months. Conventional treatment group and lumbar drainage group accepted GOS scale at clinical follow-up after treatment for 3months. Results Compared with conventional treatment group,MRS NAA / Cr,NAA / Cho were significantly higher and Cho / Cr were significantly lower in lumbar drainage group at 10 th day after traumatic brain injury（ all P〈0. 05）. Compared with conventional treatment group,CDR scores were significant lower and GOS scores were significantly higher in lumbar drainage group after treatment for3 months（ all P〈0. 05）. Conclusions LCD can improve the regional cerebral metabolism,cognitive dysfunction and clinical outcomes of patients with traumatic t SAH.