腰大池持续引流治疗创伤性蛛网膜下隙出血的效果

Effect of drainage subarachnoid lumbar space treating traumatic subarachnoid hemorrhage

目的探讨应用早期腰大池持续引流术治疗外伤性蛛网膜下腔出血的效果。方法选择三河市医院（以下简称“我院”）2011年1月～2014年1月收治采用早期行腰大池持续引流脑脊液治疗的外伤性蛛网膜下腔出血患者100例作为观察组，另选择我院2008年1月～2010年12月收治入院行每天腰穿术放脑脊液治疗的外伤性蛛网膜下腔出血患者100例作为对照组，比较两组患者临床疗效、不同时间脑CT灌注成像参数[脑血容量（CBV）、脑血流量（CBF）、对比剂达峰时间（TTP）、对比剂平均通过时间（MTT）]、格拉斯哥昏迷评分（GOS）和复发情况。结果①临床疗效：观察组100例患者头痛消失时间、颅内压力恢复正常时间、脑脊液转清时间、发生脑积水、硬膜下积液发生率明显低于对照组，差异有统计学意义（P〈0．05）。而恶心呕吐消失例数明显高于对照组，差异有统计学意义（P〈0．05）。②不同时间脑CT灌注成像参数比较：对照组患者伤后第7天CBV、CBF、TTP、MTT与第3天比较差异有统计学意义（P〈0．05）；观察组患者伤后第7天CBV、CBF、TTP与第3天比较差异有统计学意义（P〈0．05）；观察组患者伤后第7天CBV、CBF明显高于对照组，TTP、MTT明显低于对照组，差异有统计学意义（P〈0．05）；第14天观察组患者CBV、CBF明显高于对照组，差异有统计学意义（P〈0．05）；③GOS评分比较：治疗后6个月时，观察组失访1例，对照组失访3例，两组其余患者GOS预后评分比较差异有统计学意义（P〈0．05）；④复发情况：6个月随访期间，观察组脑水肿复发2例，复发率为5．1％，对照组脑水肿复发9例，复发率为23．1％，两组复发率比较差异有统计学意义（P〈0．05）。结论行早期腰大池引流治疗外伤性蛛网膜下腔出血术后恢复时间短，并发症发生率低，可克服反复腰穿术放脑脊液引流量有限且容易引发局部感染等缺陷，可在临床推广使用。

Objective To study the effect of drainage subarachnoid lumbar space treating traumatic subarachnoid hem- orrhage. Methods From January 2011 to January 2014, in Sanhe Hospital （＂our hospital＂ for short）, 100 patients with early drainage subarachnoid lumbar space treating traumatic subarachnoid hemorrhage were selected as observation group, 100 patients with lumbar puncture drainage cerebrospinal fluid treating traumatic subarachnoid hemorrhage from January 2008 to December 2010 in our hospital were selected as control group. The clinical curative effect, brain CT perfusion imaging parameters [cerebral blood volume （CBV）, cerebral blood flow （CBF）, contrast agent tmax （TTP）, average contrast agent through time （determined by MTT）] at different time, Glasgow coma scale （GOS） and relapse in two groups were compared. Results ①The clinical curative effect： headache disappear time, intracranial pressure returned to normal time, cerebrospinal fluid, the incidence of hydrocephalus, subdural effusion of patients in observation group were significantly lower than those in control group, the differences were statistically significant （P 〈 0.05）. The cases of nausea and vomiting disappeared were significantly higher than that of control group, the difference was .statistically significant （P 〈 0.05）. ②Comparison of different time brain CT perfusion imaging parameters： CBV, CBF, TrP, MTI＇ at the 7th day in control group were compared with those at the 3rd day, the differences were statistically significant （P 〈 0.05）; CBV, CBF, TIP at the 7th day in observation group were compared with those at the 3rd day, the differences were statistically significant （P 〈 0.05）; at the 7th day, CBV, CBF in observation group were significantly higher than those in control group, TrP, MTI were significantly lower than those in control group, the differences were statistically significant （P 〈 0.05）; at 14th day, CBV, CBF in observation group were significantly higher than those in control group, the differences were statistically significant （P 〈 0.05）. ③GOS score comparison： after treatment for 6 months, 1 case was lost during follow-up in observation group, 3 cases was lost during follow-up in control group, GOS prognosticscore of the rest of patients in two groups were compared, the difference was statistically significant （P 〈 0.05）. ④Relapse situation： at 6 months follow-up period, in observation group, brain edema recurrence was 2 cases, recurrence rate was 5.1%; in control group, brain edema recurrence was 9 cases, recurrence rate was 23.1%, two groups were com- pared, the difference was statistically significant （P 〈 0.05）. Conclusion Drainage subarachnoid lumbar space treating traumatic subarachnoid hemorrhage has short postoperative recovery time, low complication rate, it can overcome the re- peated lumbar puncture technique put cerebrospinal fluid of limited and easy to cause the defects such as local infec- tion, it should be used widely in clinic.