动脉瘤夹闭术后腰大池引流联合3H治疗蛛网膜下腔出血的效果及对血管活性因子的影响

Clinical Effect of Lumbar Cistern Drainage Combined with 3H therapy in the Subarachnoid Hemorrhage after Aneurysm Clipping Operation and its Effect on Vasoactive Factors

【目的】探讨动脉瘤夹闭术后腰大池引流联合高血压、高血容量及血液稀释（3H）治疗蛛网膜下腔出血的效果及对血管活性因子的影响。【方法】选取2016年5月至2017年5月本院收治的蛛网膜下腔出血患者116例，随机分为对照组及观察组两组各58例，对照组应用动脉瘤夹闭术后腰大池引流治疗，观察组在对照组基础上联合3H治疗。比较两组患者治疗效果、术后并发症、血清C反应蛋白（CRP）及S100水平及血浆舒张因子（NO）、收缩因子（ET-1）、血栓素B2（TXB2）及人6-酮-前列环素F1d（6-K-PGF1α）水平变化。【结果】观察组治疗有效率为93．1％，明显高对照组的70．4％（P〈0.05）；观察组患者头痛评分、脑血管痉挛程度明显低于对照组（P〈0．05），颅脑积水及死亡率明显低于对照组（P〈0．05）。干预前，两组患者血清CRP、S100水平及血浆N0、ET-1、TXB2及6-K-PGF1α水平比较无明显差异（P〉0．05）；干预后，观察组各指标明显低于对照组（P〈0．05）。【结论】动脉瘤夹闭术后腰大池引流联合3H治疗蛛网膜下腔出血安全可靠，可减少患者并发症并保证存活率，治疗效果更为理想，值得临床推广应用。

[Objective] To study the clinical effect of lumbar cistern drainage combined with hypertension, high blood volume and hemodilution （3H） on subarachnoid hemorrhage after aneurysm clipping operation and its effect on vasoactive factors. [Methods]From May 2016 to May 2017, 116 patients with subarachnoid hem- orrhage were randomly divided into two groups： the control group （n = 58） and the observation group （ n 58）. The control group was treated with lumbar cistern drainage after aneurysm clipping. The observation group combined with 3 H therapy on the basis of the control group. The therapeutic effects, postoperative complications, serum C-reactive protein （CRP） and S100 levels, plasma diastolic factor （NO）, contraction factor （ET-1）, thromboxane B2 （TXB2） and human 6-keto-prostacyclin （6-K-PGF1α） levels were compared between the two groups.[Results]The effective rate of treatment in the observation group was 93.1%, which was significantly higher than that in the control group 70.4% （ P〈0.05） ;the headache score and cerebral vas- ospasm in the observation group were significantly lower than those in the control group （ P 〈0.05）, and the craniocerebral hydrocephalus and mortality were significantly lower than those in the control group （ P 0.05）. Before intervention, there was no significant difference in serum CRP,S100 level and plasma NO,ET-1, TXB2 and 6-K-PGF1α levels between the two groups （ P〉0.05）, and after intervention, the indexes in the observation group were significantly lower than those in the control group （ P〈0.05）.[Conclusion] The treatment of subarachnoid hemorrhage by lumbar cistern drainage combined with 3H after aneurysm clipping is safe and reliable. It can reduce complications and ensure survival rate.