动脉瘤性蛛网膜下腔出血后不同脑脊液引流方式的疗效对比

Comparison of the curative effect of different cerebrospinal fluid drainage for the patients with aneurysmal subarachnoid hemorrhage

目的分析腰穿与腰大池引流在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)术后发生分流依赖性脑积水的影响。方法回顾性分析福建医科大学附属第二医院神经外科2013-01—2016-09收治的137例动脉瘤性蛛网膜下腔出血患者,分析腰穿与腰大池引流在预防aSAH后分流依赖性脑积水中的疗效。结果 36例(26.28%)发生分流依赖性脑积水,Fisher分级Ⅰ~Ⅱ的患者中腰穿及腰大池引流组分流依赖性脑积水的发生率无明显差异(P>0.05)。Fisher分级Ⅲ~Ⅳ的患者中2组脑积水发生率有明显差异(P<0.05)。结论腰大池置管引流可明显降低Fisher分级Ⅲ~Ⅳ患者脑积水的发生率,Fisher分级Ⅰ~Ⅱ的患者可考虑仅行腰穿。

Objective To analyze the influence of Lumbar puncture and lumbar pool drainage in the shunt-dependent hydrocephalus caused by aneurysmal subarachnoid hemorrhage. Methods The medical records of 137 patients with aneurysmal subarachnoid hemorrhage treated in the Second Affiliated Hospital of Fujian Medical University from January 2013 to September 2016 were retrospectively studied. The effects of lumbar puncture and lumbar pool drainage in prevention of shunt dependency hydrocephalus after aSAH were analyzed. Results Of 137 patients, 36（26.28%） underwent shunt operation to treat shunt-dependent hydrocephalus. Compare with the incidence of hydrocephalus in the group of lumbar puncture and lumbar pool drainage that the patients with Fisher grade Ⅰ - Ⅱ , no obvious difference was found. But the difference was obvious in the patients with Fisher grade Ⅲ-Ⅳ. Conclusion The aSAH patients with Fisher grade Ⅲ-Ⅳare more likely to avoid the shunt-depended hydrocephalus by continuous lumbar cisterna drainage. And the aSAH patients with Fisher grade Ⅰ - Ⅱ maybe just need lumbar puncture to avoid the shunt-depended hydrocephalus.