动脉瘤夹闭术后脑脊液引流与直接缝合硬脑膜对脑积水及脑血管痉挛风险的影响

Effect of Cerebrospinal Fluid Drainage and Direct Suture of Dura Mater on the Risk of Hydrocephalus and Cerebral Vasospasm after Aneurysm Clipping

目的:探讨动脉瘤夹闭术后脑脊液引流与直接缝合硬脑膜对脑积水、脑血管痉挛风险(CVS)的影响。方法:选取笔者所在医院2015年5月-2016年5月收治的脑动脉瘤并蛛网膜下腔出血(SAH)患者102例,均接受动脉瘤夹闭术治疗。根据随机数字表法分成A组与B组,各51例,A组术后行脑脊液引流,B组术后直接缝合硬脑膜。比较两组术后脑积水、脑血管痉挛发生率,并分析术后脑积水、脑血管痉挛发生的危险因素。结果:A组脑积水、CVS发生率为5.88%、3.92%,低于B组的19.61%、15.69%,且A组总发生率为9.80%,低于B组的35.29%,差异有统计学意义(P<0.05)。发生脑积水、CVS患者的Hunt-HessⅢ～Ⅳ级、大型动脉瘤、无脑脊液引流占比分别为52.17%、21.74%、78.26%,高于未发生患者的22.78%、2.53%、41.77%,差异均有统计学意义(P<0.05)。Logistic回归性分析提示Hunt-HessⅢ～Ⅳ级、大型动脉瘤、无脑脊液引流是患者动脉瘤夹闭术后脑积水、CVS发生的独立危险因素(P<0.05)。结论:动脉瘤夹闭术后不进行脑脊液引流是导致术后出现脑积水、CVS的重要因素,与直接缝合硬脑膜相比,术后行脑脊液引流能降低脑积水、CVS风险。

Objective:To investigate the effects of cerebrospinal fluid drainage and direct suture of dura mater on the risk of hydrocephalus and cerebral vasospasm(CVS)after aneurysm clipping.Method:A total of 102 patients with cerebral aneurysm and subarachnoid hemorrhage(SAH)admitted to our hospital from May 2015 to May 2016 were treated with aneurysm clipping.According to the random number table method,51 cases were divided into group A and group B.Group A was followed by cerebrospinal fluid drainage,and group B was directly sutured.The incidence of hydrocephalus and cerebral vasospasm was compared between the two groups,and the risk factors of postoperative hydrocephalus and cerebral vasospasm were analyzed.Result:The incidence of hydrocephalus and CVS in group A was 5.88%and 3.92%,which was lower than 19.61%and 15.69%in group B,and the total incidence rate in group A was 9.80%,which was lower than 35.29%in group B,the differences were statistically significant(P<0.05).The percentage of Hunt-HessⅢ-Ⅳ,large aneurysm and cerebrospinal fluid drainage of patients with hydrocephalus and CVS were 52.17%,21.74%and 78.26%,respectively,which were higher than 22.78%,2.53%and 41.77%of patients without hydrocephalus and CVS,the differences were statistically significant(P<0.05).Logistic regression analysis indicated that Hunt-HessⅢ-Ⅳ,large aneurysm and cerebrospinal fluid-free drainage were independent risk factors for hydrocephalus and CVS after aneurysm clipping(P<0.05).Conclusion:Cerebrospinal fluid drainage after aneurysm clipping is an important factor leading to hydrocephalus and CVS after operation.Compared with direct suture dura mater,cerebrospinal fluid drainage can reduce the risk of hydrocephalus and CVS.