腰大池引流治疗动脉瘤性蛛网膜下腔出血的疗效观察

目的探讨腰大池引流治疗动脉瘤性蛛网膜下腔出血(aSAH)的疗效。方法选取2017年3月至2019年4月接受血管内栓塞手术的aSAH患者107例,分为腰大池置管组(n=53,栓塞术后行持续腰大池引流治疗)和腰穿组(n=54,栓塞术后采用常规腰椎穿刺治疗)。治疗前及治疗6个月后,采用健康状况调查表(SF-36)评价患者的生活质量改变;采用哥斯拉预后评分(GOS)评价患者的恢复情况;观察记录两组继发脑梗死、脑血管痉挛(CVS)及脑积水的发生率。结果腰大池置管组治疗6个月后的预后良好率(GOS=5分)73.58%,比腰穿组46.30%明显升高(P<0.05);腰大池置管组治疗后生活质量8个维度的评分均比治疗前及腰穿组明显升高(P<0.05);随访6个月,腰大池置管组脑梗死、脑血管痉挛及脑积水的发生率分别为2.77%、9.43%及1.89%,比腰穿组16.67%、25.93%及12.96%均有明显下降(P<0.05)。结论腰大池引流治疗可有效改善aSAH患者预后及生活质量,控制脑梗死、CVS及脑积水的发生率,具有临床应用价值。

Objective To investigate the effect of lumbar cistern drainage on GOS score,hydrocephalus occurrence and quality of life in patients with aneurysm subarachnoid hemorrhage(aSAH).Methods From March 2017 to April 2019,107 patients with aSAH who underwent endovascular embolism in Pinghu First Hospital and Zhejiang Hospital were selected as the main subjects of study.According to the random digital table,it is divided into waist pool tube group(n=53,Treatment of continuous lumbar cistern drainage after embolization)and waist piercing group(n=54,Routine lumbar puncture after embolization).After 6 months of treatment,GOS was used to evaluate the recovery of the patients,and the patients were followed up for 6 months to observe and record the incidence of secondary cerebral infarction,cerebral vasospasm(CVS)and hydrocephalus in the two groups.Results The rate of good prognosis(GOS=5 score)in the waist pool tube group was 73.58%after 6 months of treatment,which was significantly higher than that in the waist piercing group(46.30%,P<0.05).The scores of eight dimensions of quality of life in the waist pool tube group were significantly higher than those before treatment and in the waist piercing group(P<0.05).The incidence of cerebral infarction,cerebral vasospasm and hydrocephalus in the waist pool tube group was 2.77%,9.43%and 1.89%,compared with the waist piercing group(16.67%),25.93%and 12.96%were significantly decreased(P<0.05).Conclusion Lumbar cistern drainage can effectively improve the prognosis and quality of life of aSAH patients,control the incidence of cerebral infarction,CVS and hydrocephalus,and has clinical application value.