早期开颅夹闭联合脑室外引流治疗对高分级aSAH的影响

Effect of Early Craniotomy Clipping Combined with Extraventricular Drainage on High-grade aSAH

目的:探讨早期开颅夹闭联合脑室外引流治疗对高分级动脉瘤性蛛网膜下腔出血(aSAH)的影响。方法:回顾性分析2018年1月-2020年12月竹山县人民医院神经外科收治的65例高分级aSAH患者的临床资料,其中30例患者接受腰大池引流治疗(对照组),35例患者接受早期开颅夹闭联合脑室外引流(观察组)。比较两组并发症发生率、手术指标、意识障碍改善情况、美国国立卫生研究院卒中量表(NIHSS)、日常生活功能量表(ADL)评分、格拉斯哥预后(GOS)优良率。结果:观察组急性脑积水、症状性脑血管痉挛、慢性症状性脑积水发生率均低于对照组(P<0.05);观察组术后1个月的意识障碍改善率高于对照组(P<0.05);两组再出血发生率、颅内感染率与术后6个月死亡率比较差异无统计学意义(P>0.05);两组术后mRS评分、NIHSS评分、ADL评分、GOS优良率比较差异无统计学意义(P>0.05)。结论:早期开颅夹闭联合脑室外引流治疗高分级aSAH的效果确切,可改善患者早期意识障碍。

Objective:To investigate the effect of early craniotomy clipping combined with extraventricular drainage on high-grade aneurysmal subarachnoid hemorrhage(aSAH).Method:The clinical data of 65 patients with high-grade aneurysmal subarachnoid hemorrhage treated in the Department of Neurosurgery of Zhushan County People’s Hospital from January 2018 to December 2020 were analyzed retrospectively.Among them,30 patients received lumbar cistern drainage(control group),and 35 patients received early craniotomy clipping combined with extraventricular drainage(observation group).The incidence of complications,surgical indicators,improvement of consciousness disorder,National Institutes of Health stroke scale(NIHSS),function of daily living scale(ADL)score and excellent and good rate of Glasgow outcome scale(GOS)were compared between the two groups.Result:The incidence of acute hydrocephalus,symptomatic cerebral vasospasm and chronic symptomatic hydrocephalus in the observation group was lower than that in the control group(P<0.05);the improvement rate of consciousness disturbance in the observation group was higher than that in the control group one month after operation(P<0.05);there were no significant differences in the incidence of rebleeding,intracranial infection rate,mortality at 6 months after surgery between the two groups(P>0.05);there were no significant differences in mRS score,NIHSS score,ADL score,GOS excellent and good rate(P>0.05).Conclusion:Early craniotomy clipping combined with external ventricular drainage is effective in the treatment of high-grade aSAH,and can improve patients’early consciousness disorder.