腰大池置管术在动脉瘤性蛛网膜下腔出血后血管痉挛中的作用

The role of lumbar drainage in symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage

目的 探讨动脉瘤性蛛网膜下腔出血后症状性血管痉挛及其预后的影响因素,评估腰大池置管引流术的治疗效果.方法 回顾性分析浙江大学附属第二医院神经外科自2012年1月至2013年12月175例动脉瘤性蛛网膜下腔出血患者的临床资料,采用多因素回归分析,通过性别、年龄、Hunt-Hess评分、改良Fisher分级和腰大池置管引流5个影响因素来评估蛛网膜下腔出血后症状性血管痉挛、痉挛相关性脑梗死、平均住院时间和出院1个月后Glasgow预后评分等预后指标.结果 诸多因素影响蛛网膜下腔出血患者的预后,其中腰大池置管是症状性血管痉挛（OR =0.243, 95％ CI：0.119～0.497）和痉挛相关性脑梗死（OR=0.305,95％ CI：0.154～0.604）的独立保护性因素.腰大池置管的患者Glasgow预后评分高于不置管的患者（P＜0.05）,但是腰大池置管引流延长了平均住院时间（P＜0.05）.结论 在动脉瘤性蛛网膜下腔出血的患者中,腰大池置管引流能有效缓解症状性脑血管痉挛,改善患者的预后.

Objective To investigate the risk factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and evaluate the effect of lumbar drainage of cerebrospinal fluid on vasospasm.Methods In this retrospective controlled-cohort study, 175 patients with aneurysmal subarachnoid hemorrhage met our study criteria between January 2012 and December 2013.By multi-factor regression analysis, gender, age, Hunt-Hess grade, modified Fisher grade and lumbar drainage were analyzed.The outcomes were assessed by the presence or absence of symptomatic cerebral vasospasm and vasospasm-related infarction, and the mean days of hospital stay and score of Glasgow Outcome Scale at 1-month follow-up.Results Several factors affected the prognosis of subarachnoid hemorrhage.Lumbar drainage was a protective factor of symptomatic cerebral vasospasm （OR =0.243, 95% CI： 0.119-0.497） and vasospasm-related infarction （OR =0.305, 95% CI： 0.154-0.604）.The patients with lumbar drainage had higher score of Glasgow Outcome Scale （P 〈 0.05）.But the patients with lumbar drainage had longer hospital stay （P 〈 0.05）.Conclusions Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage markedly reduced the risk of symptomatic cerebral vasospasm and improved outcome.