持续腰大池引流术与多次腰椎穿刺术治疗重型颅脑损伤合并蛛网膜下腔出血的临床分析

Clinical analysis of continuous lumbar cistern drainage and multiple lumbar puncture in the treatment of severe craniocerebral injury combined with subarachnoid hemorrhage

目的:分析持续腰大池引流术引流与多次腰椎穿刺术引流治疗重型颅脑损伤合并蛛网膜下腔出血(SAH)的临床效果。方法:回顾性选择2018年5月至2020年8月进行治疗的64例重型颅脑损伤合并SAH患者作为研究对象;将采用多次腰椎穿刺术引流治疗的32例患者纳入多次穿刺组,将采用持续腰大池引流术治疗的32例患者纳入持续引流组,对比两组各时间段血性脑脊液红细胞计数、内皮素(ET-1)、一氧化氮(NO)、加拿大神经功能缺损评分量表(CNS)评分、术后1个月并发症(脑积水、脑梗死、癫痫)发生情况。结果:持续引流组血性脑脊液红细胞计数、ET-1水平均低于多次穿刺组,NO浓度高于多次穿刺组(P<0.05);持续引流组CNS评分低于多次穿刺组(P<0.05);持续引流组术后1个月的并发症总发生率为3.13%低于多次穿刺组的18.75%(P<0.05)。结论:持续腰大池引流术可有效廓清重型颅脑损伤合并SAH患者的血性脑脊液,改善患者脑血流灌注及神经功能,安全性较高。

Objective:To analyze the clinical effects of continuous lumbar cistern drainage and multiple lumbar puncture drainage in the treatment of severe craniocerebral injury combined with subarachnoid hemorrhage(SAH).Methods:64 patients with severe craniocerebral injury combined with SAH who were treated from May 2018 to August 2020 were retrospectively chosen as the research objects;32 patients who underwent multiple lumbar puncture drainage treatment were included in the multiple puncture group and 32 patients treated with continuous lumbar cistern drainage were included in the continuous drainage group,with the blood cerebrospinal fluid red blood cell count,endothelin(ET-1),nitric oxide(NO),Canadian neurological deficit score scale(CNS)score,and the occurrence of complications(hydrocephalus,cerebral infarction,epilepsy)one month after surgery compared.Results:The blood cerebrospinal fluid red blood cell count and ET-1 levels in the continuous drainage group were lower than those in the multiple puncture group,and the NO concentration was higher than that in the multiple puncture group(P<0.05);the CNS score of the continuous drainage group was lower than that of the multiple puncture group(P<0.05);the total incidence of complications in the continuous drainage group one month after surgery was 3.13%,lower than that of the multiple puncture group(18.75%)(P<0.05).Conclusion:Continuous lumbar cistern drainage is safe and can effectively remove bloody cerebrospinal fluid in patients with severe craniocerebral injury combined with SAH,improve cerebral blood perfusion and neurological function.