腰大池引流对动脉瘤破裂出血术后脑积水的预防效果及预后相关因素分析

Prevention effect of lumbar cistern drainage on hydrocephalus after ruptured aneurysm hemorrhage and related prognostic factors analysis

目的:探讨腰大池引流对动脉瘤破裂出血术后脑积水的预防效果,并分析影响患者脑积水的相关因素。方法:回顾性抽取我院2019-01~2020-01收治的130例动脉瘤破裂出血患者的临床资料,根据手术方式不同分为观察组67例、对照组63例,观察组采取腰大池引流术放出脑脊液,对照组采取常规腰椎穿刺术放出脑脊液,比较两组患者术后头痛程度以及时间、脑脊液红细胞数目变化情况和脑积水发生率,同时对影响患者预后(脑积水)的因素进行单因素以及多因素Logistic回归分析。结果:观察组头疼程度评分以及头痛持续时间均明显低于对照组,脑脊液压力数值在观察组中也明显低于对照组(P<0.05);术后第1天时,两组脑脊液红细胞数值比较没有明显差异(P>0.05),术后第2天和第3天时均明显降低,第7天时均恢复正常值范围,但观察组第1~7天均比对照组脑脊液红细胞数值降低更显著(P<0.05);在住院期间,两组脑积水发生率比较没有明显差异(P>0.05),出院半年后,观察组脑积水发生率明显低于对照组(P<0.05);单因素分析及多因素分析显示Hunt-Hess分级以及脑室扩大为腰大池引流后出现脑积水的独立危险因素(P<0.05)。结论:对动脉瘤破裂出血患者采取腰大池引流术,不仅有利于缓解患者头痛程度,降低脑脊液压力,同时还能减少脑积水发生率;Hunt-Hess分级以及脑室扩大为腰大池引流后出现脑积水的独立危险因素。

Objective: To investigate the prevention effect of lumbar cistern drainage on hydrocephalus after aneurysm rupture and hemorrhage, and to analyze the related factors affecting patients with hydrocephalus.Methods: The clinical data of 130 patients with ruptured aneurysm bleeding admitted to the Second People’s Hospital of Jiaozuo City from January 2019 to January 2020 were retrospectively analyzed. According to different surgical methods, they were divided into observation group(n=67) and control group(n=63).The cerebrospinal fluid(CSF) was discharged by conventional lumbar puncture in the control group and lumbar cistern drainage in the observation group.The postoperative headache degree, headache duration, CSF erythrocyte count changes and hydrocephalus incidence were compared between the two groups.Univariate and multivariate Logistic regression analysis was performed on the factors affecting the prognosis of patients.Results:The headache severity score and headache duration in the observation group were significantly lower than those in the control group, and the value of cerebrospinal fluid pressure was also significantly lower than that in the control group, the differences were statistically significant(P<0.05).On postoperative day 1, there was no significant difference in CSF erythrocyte values between the two groups(P>0.05), decreased significantly on the second and third days after operation, and returned to the normal range on the seventh day.However, the CSF erythrocyte values in the observation group from day 1 to day 7 were significantly lower than those in the control group(P<0.05).There was no significant difference in the incidence of hydrocephalus between the two groups during hospitalization(P>0.05), the incidence of hydrocephalus in the observation group was significantly lower than that in the control group(P<0.05).Univariate analysis and multivariate analysis showed that Hunt-Hess grade and ventricular enlargement were independent risk factors for hydrocephalus after lumbar cister drainage(P<0.05).Conclusion: lumbar cistern drainage can relieve headache, reduce cerebrospinal fluid pressure and reduce the incidence of hydrocephalus in patients with ruptured aneurysm bleeding.Hunt-Hess grade and ventricular enlargement are independent risk factors for hydrocephalus after lumbar cisterne drainage, which should be paid more attention in clinic.