血性脑脊液引流在重症动脉瘤性蛛网膜下腔出血中的应用效果

Application effect of hemorrhagic cerebrospinal fluid drainage in severe aneurysmal subarachnoid hemorrhage

目的探讨血性脑脊液引流在重症动脉瘤性蛛网膜下腔出血(SaSAH)中的应用效果。方法回顾性分析2020年5月至2021年9月于上饶市人民医院神经外科接受治疗的60例SaSAH患者临床资料,按照治疗方法分为对照组和观察组,每组各30例。对照组患者采用常规治疗,观察组患者在对照组基础上加用血性脑脊液引流。比较两组患者的恢复状况(头痛持续时间、脑膜刺激征持续时间、住院时间);比较两组患者治疗前后的血氧状况(股动脉血氧饱和度、颈静脉血氧饱和度、中心静脉血氧饱和度)、脑氧代谢[动脉血氧含量(CaO_(2))、颈内静脉含氧量(CjvO_(2))、颈动脉内静脉球部血氧差(Da-jvO_(2))、脑氧摄取率(CEO_(2))]状况;比较两组患者治疗期间并发症发生情况。随访3个月,采用改良Rankin量表评估比较两组患者的预后状况。结果观察组患者的头痛持续时间、脑膜刺激征持续时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者的血氧状况指标比较,差异无统计学意义(P>0.05);治疗后,两组患者的股动脉血氧饱和度、颈静脉血氧饱和度、中心静脉血氧饱和度均高于本组治疗前,差异有统计学意义(P<0.05),但治疗后两组间比较,差异无统计学意义(P>0.05)。治疗前,两组患者的脑氧代谢状况指标比较,差异无统计学意义(P>0.05);治疗后,两组患者的CaO_(2)、CjvO_(2)、CEO_(2)均高于本组治疗前,Da-jvO_(2)低于本组治疗前,且观察组的CaO_(2)、CjvO_(2)、CEO_(2)高于对照组,Da-jvO_(2)低于对照组,差异有统计学意义(P<0.05)。观察组的并发症总发生率高于对照组,差异有统计学意义(P<0.05)。观察组患者术后随访3个月的预后优良率高于对照组,差异有统计学意义(P<0.05)。结论血性脑脊液引流可调节SaSAH患者脑氧代谢状况,加快患者恢复进程,改善预后,值得临床推广。

Objective To explore the application effect of bloody cerebrospinal fluid drainage on severe aneurysmal subarachnoid hemorrhage(SaSAH).Methods The clinical data of 60 SaSAH patients treated in the Department of Neurosurgery,Shangrao People's Hospital from May 2020 to September 2021 were retrospectively analyzed.According to the treatment method,they were divided into the control group and the observation group,with 30 cases in each group.The control group received conventional treatment,while the observation group received hemorrhagic cerebrospinal fluid drainage on the basis of the control group.The recovery status(duration of headache,duration of meningeal irritation,length of hospital stay)was compared between the two groups.The blood oxygen status(femoral artery oxygen saturation,cervical venous oxygen saturation,central venous oxygen saturation),cerebral oxygen metabolism(arterial oxygen content[CaO_(2)],internal jugular venous oxygen content[CjvO_(2)],difference of arterial-jugular venous oxygen[Da-jvO_(2)],cerebral oxygen uptake rate[CEO_(2)])before and after treatment were compared between the two groups.Complications during treatment were compared between the two groups.After 3 months of follow-up,the modified Rankin scale was used to evaluate and compare the prognosis of the two groups.Results The duration of headache,duration of meningeal irritation and length of hospital stay in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in blood oxygen status between the two groups before treatment(P>0.05).After treatment,the femoral artery oxygen saturation,cervical venous oxygen saturation and central venous oxygen saturation of the two groups were higher than those before treatment,and the differences were statistically significant(P<0.05),but there was no statistically significant difference between the two groups after treatment(P>0.05).Before treatment,there was no significant difference in cerebral oxygen metabolism between the two groups(P>0.05).After treatment,CaO_(2),CjvO_(2),and CEO_(2) of the two groups were higher than those before treatment,and the Da-jvO_(2) was lower than that before treatment,and the CaO_(2),CjvO_(2),CEO_(2) of observation group were higher than those of the control group,the Da-jvO_(2) was lower than that of the control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The excellent and good prognosis rate of the observation group was higher than that of the control group after 3 months follow-up,and the difference was statistically significant(P<0.05).Conclusion Bloody cerebrospinal fluid drainage in patients with SaSAH can regulate the cerebral oxygen metabolism,accelerate the recovery process,and improve the prognosis,thus it is worthy of clinical promotion.