动脉瘤夹闭术后行脑脊液引流对患者脑积水、脑血管痉挛及血清类胰岛素1号生长因子、可溶性血管细胞黏附分子-1的影响

Effect of Cerebrospinal fluid drainage after aneurysm clipping on hydrocephalus, cerebral vasospasm and serum IGF - 1, sVCAM - 1

目的探讨颅内动脉瘤合并蛛网膜下腔出血患者行动脉瘤夹闭术后进行脑脊液引流的应用价值。方法选取颅内动脉瘤合并蛛网膜下腔出血患者84例，将入选患者按照随机数字表法分为研究组（n=42）与对照组（n=42），对照组动脉瘤夹闭术后不放置腰大池引流，研究组动脉瘤夹闭术后在腰大池放置引流管进行引流。比较分析两组脑积水和脑血管痉挛变化情况、治疗前后血清类胰岛素1号生长因子（insulin—like growth factor-1，IGF-1）与可溶性血管细胞黏附分子-1（soluble vascular cell adhesion molecule-1，sVCAM—1）水平变化。结果研究组脑积水发生率为4．8％，明显低于对照组的14．3％（χ^2=9．743，P〈0．05）；研究组脑血管痉挛发生率为7．1％，明显低于对照组的19．0％（χ^2=11．802，P〈0．05）；两组颅内感染及切口脑脊液漏等其他并发症发生率差异均无统计学意义（χ^2=2．074、2．125，均P〉Q05）。术前两组患者血清IGF．1、sVCAM．1水平比较差异均无统计学意义（t=0．417、0．603，均P〉0．05）；术后第8天，研究组患者血清IGF-1、sVCAM-1水平明显均低于对照组（t=7．335、6．856，均P〈0．05）。结论动脉瘤夹闭术后在腰大池放置引流管进行引流，有益于减少脑积水与脑血管痉挛的发生率，抑制血清IGF-1、sVCAM-1的表达，不良反应少，值得应用。

Objective To investigate the value of cerebrospinal fluid drainage after aneurySm clipping in patients with intracranial aneurysm complicated with subarachnoid hemorrhage. Methods 84 intracranial aneurysms patients with subarachnoid hemorrhage were selected, and they were randomly divided into study group （n= 42） and control group （ n = 42 ） ： The control group used simple suture after aneurysm clipping, the study group was given lumbar cistern drainage by implementation of the dural suture tube after aneurysm clipping. Before and after hydro- cephalus and cerebral vasospasm, treatment changes of serum insulin - like growth factor 1 （ IGF - 1 ） and soluble vascular cell adhesion molecule - 1 （ sVCAM - 1 ） levels were compared between the two groups. Results The incidence rate of hydrocephalus of the study gruop was 4.8% ,which was significantly lower than the 14.3% of the control group （ χ^2 = 9. 743, P 〈 0.05 ）. The incidence rate of cerebral vasospasm of the study group was 7.1% , which was significantly lower than 19.0% of the control group （ χ^2 = 11. 802 ,P 〈 0.05 ）. The incidence rates of intracranial infection,cerebrospinal fluid leakage and other complications between the two groups had no statistically significafit differences （ χ^2 = 2.074,2.125, all P 〉 0.05 ）. The serum levels of IGF - 1 and sVCAM - 1 between the two groups had no statistically significant differences before operation （ t = 0. 417 ,0. 603 , all P 〉 0. 05 ）. At the 8th day after operation, the serum levels of sVCAM - 1 and IGF - 1 of the study group were significantly lower than those of the control group （t = 7. 335,6. 856, all P 〈 0.05 ）. Conclusion After aneurysm clipping, the lumbar cistern drainage tube drainage is beneficial to reduce hydrocephalus and cerebral vasospasm incidence,inhibit the expression of serum IGF - 1, sVCAM - 1, with less adverse reactions, it is worthy of application.