早期持续腰大池引流联合尼莫地平对动脉瘤性蛛网膜下腔出血术后脑血管痉挛的影响

Effects of Early Continuous Lumbar Cerebrospinal Fluid Drainage Combined with Nimodipine on Cerebral Vasospasm after Surgery for Aneurysmal Subarachnoid Hemorrhage

目的研究动脉瘤性蛛网膜下腔出血(aSAH)术后采用腰大池持续引流联合尼莫地平治疗对脑血管痉挛(CVS)患者预后的影响。方法回顾性分析2017年4月-2019年4月我院收治的87例aSAH患者的临床资料,根据治疗方案不同分为观察组46例和对照组41例。2组均给予常规化疗。对照组在此基础上酌情进行腰椎穿刺,观察组给予腰大池持续引流,比较2组治疗后CVS等并发症发生情况和术后6个月时的预后。结果 2组术后1、3、7、14 d脑脊液红细胞计数逐渐降低,且观察组术后3、7、14 d时脑脊液红细胞计数显著低于对照组(P<0.05)。术后14 d,2组血管内皮因子、肿瘤坏死因子-α和白介素-8水平显著降低,且观察组低于对照组(P<0.05);2组治疗后脑血容量、脑血流量较治疗前显著降低,且观察组高于对照组(P<0.05);2组对比剂达峰时间及对比剂平均通过时间较治疗前升高,且观察组低于对照组(P<0.05);观察组脑积水和CVS发生率低于对照组(P<0.05)。观察组术后6个月时GOS评分优于对照组,预后良好率高于对照组(P<0.05)。结论腰大池持续引流联合尼莫地平用于aSAH术后治疗,可促进脑脊液中红细胞清除和脑脊液循环,减轻炎症反应,改善微循环和脑组织灌注,减少CVS等并发症发生,改善患者预后。

Objective To study the effects of early continuous lumbar cerebrospinal fluid drainage(CLCFD) combined with Nimodipine on cerebral vasospasm(CVS) and prognosis in patients after surgery for aneurysmal subarachnoid hemorrhage(aSAH). Methods The clinical data of 87 patients with aSAH in our hospital from April 2017 to April 2019 were retrospectively analyzed. All patients were divided into observation group(n=46) and control group(n=41) according to different treatment regimens. The two groups were given conventional treatment methods. The control group was given lumbar puncture as appropriate on this basis, and the observation group was treated with CLCFD. The occurrences of complications such as CVS after treatment and prognosis in 6 months after surgery were compared between the two groups. Results The RBC count of cerebrospinal fluid(CSF) in the two groups was decreased gradually at the 1, 3, 7 and 14 days after surgery, and the RBC count of CSF in the observation group was significantly lower than that in the control group at 3, 7 and 14 days after surgery(P<0.05). At 14 days after surgery, the levels of vascular endothelial growth factor(VEGF), tumor necrosis factor-α(TNF-α) and interleukin(IL)-8 were significantly lower in both groups, which were lower in the observation group than in the control group(P<0.05). The cerebral blood volume and cerebral blood flow in the two groups were significantly lower than those before treatment, which was higher in the observation group than in the control group(P<0.05). The peak time and average passage time of the contrast agent in the two groups were higher than that before treatment, which was lower in the observation group than in the control group(P<0.05). The incidence of hydrocephalus and CVS in the observation group was lower than that in the control group(P<0.05). At six months after surgery, the GOS score in the observation group was higher than that of the control group, and the good prognosis rate was higher than that of the control group(P<0.05). Conclusion CLCFD combined with Nimodipine for postoperative aSAH treatment can promote erythrocyte clearance in CSF and CSF circulation, reduce inflammatory response, improve microcirculation and cerebral perfusion, reduce occurrence of complications such as CVS, and improve patient prognosis.