持续腰大池引流术与脑脊液置换术治疗自发性蛛网膜下腔出血患者的效果比较

Comparison of effects of continuous lumbar cistern drainage and cerebrospinal fluid replacement in treatment of patients with spontaneous subarachnoid hemorrhage

目的:比较持续腰大池引流术与脑脊液置换术治疗自发性蛛网膜下腔出血患者的效果。方法:选取2022年1月至2023年10月该院收治的60例自发性蛛网膜下腔出血患者进行前瞻性研究,按照随机数字表法将其分为研究组和对照组各30例。对照组采用脑脊液置换术治疗,研究组采用持续腰大池引流术治疗,比较两组临床相关指标水平、手术前后颅内压、预后良好率、术后1个月内并发症发生率和术后神经功能指标[血清神经轴突导向因子-1(netrin-1)、基质金属蛋白酶-9(MMP-9)]水平。结果:研究组血肿清除率高于对照组,头痛消失时间、颅内压恢复正常时间和脑脊液转清时间均短于对照组,差异有统计学意义(P<0.05);术后5、7 d,研究组颅内压均低于对照组,差异有统计学意义(P<0.05);研究组预后良好率为93.33%(28/30),高于对照组的73.33%(22/30),差异有统计学意义(P<0.05);研究组术后并发症发生率为3.33%(1/30),低于对照组的26.67%(8/30),差异有统计学意义(P<0.05);术后1个月,两组MMP-9水平均低于术后5 d,且研究组低于对照组,两组netrin-1水平均高于术后5 d,且研究组高于对照组,差异有统计学意义(P<0.05)。结论:持续腰大池引流术治疗自发性蛛网膜下腔出血患者可提高预后良好率,改善临床相关指标和神经功能指标水平,降低颅内压和并发症发生率,效果优于脑脊液置换术治疗。

Objective:To compare effects of continuous lumbar cistern drainage and cerebrospinal fluid replacement in treatment of patients with spontaneous subarachnoid hemorrhage.Methods:A prospective study was conducted on 60 patients with spontaneous subarachnoid hemorrhage admitted to the hospital from January 2022 to October 2023.According to the random number table method,they were divided into study group and control group,30 cases in each group.The control group was treated with cerebrospinal fluid replacement,while the study group was treated with continuous lumbar cistern drainage.The levels of clinical related indexes,the intracranial pressure before and after the surgery,the good prognosis rate,the incidence of complications within 1 month after the surgery,and the postoperative neurological function indexes[serum netrin-1,matrix metalloproteinase-9(MMP-9)]levels were compared between the two groups.Results:The hematoma clearance rate of the study group was higher than that of the control group;the headache disappearance time,the intracranial pressure recovery time and the cerebrospinal fluid clearance time were shorter than those of the control group;and the differences were statistically significant(P<0.05).At 5 and 7 days after the surgery,the intracranial pressure levels of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).The good prognosis rate of the study group was 93.33%(28/30),which was higher than 73.33%(22/30)of the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the study group was 3.33%(1/30),which was lower than 26.67%(8/30)in the control group,and the difference was statistically significant(P<0.05).Further,1 month after the surgery,the levels of MMP-9 in the two groups were lower than those 5 days after the surgery,and that in the study group was lower than that in the control group;the levels of netrin-1 in both groups were higher than those 5 days after the surgery,and that in the study group was higher than that in the control group;and the differences were statistically significant(P<0.05).Conclusions:Continuous lumbar cistern drainage in the treatment of the patients with spontaneous subarachnoid hemorrhage can improve the good prognosis rate,improve the levels of clinical related indexes and neurological function indexes,and reduce the intracranial pressure and the incidence of complications.Moreover,it is superior to cerebrospinal fluid replacement.