超早期持续腰大池引流术联合夹闭术治疗动脉瘤性蛛网膜下腔出血的临床疗效

Clinical efficacy of ultra-early continuous lumbar cistern drainage combined with clipping for aneurysmal subarachnoid hemorrhage

目的:探讨超早期持续腰大池引流术联合夹闭术治疗动脉瘤性蛛网膜下腔出血(a SAH)的临床疗效。方法:回顾性分析2010年1月至2018年1月本院收治的a SAH患者136例的临床资料,按治疗方法分为观察组和对照组,每组68例。观察组行持续腰大池引流术联合开颅显微夹闭术治疗,对照组行单纯开颅显微夹闭术治疗。术后随访,比较两组患者的临床疗效。结果:近期疗效比较显示,术后3、7 d观察组患者脑脊液压力、大脑中动脉(MCA)流速、脑血管痉挛情况及Hunt-Hess分级均优于对照组(均P<0.05)。远期疗效比较显示,术后1个月两组患者格拉斯哥昏迷评分(GCS)差异无统计学意义(P>0.05);术后3个月及6个月,观察组患者改良Rankin量表(mRs)评分均低于对照组(均P<0.05)。结论:超早期持续腰大池引流术联合夹闭术可减少a SAH患者脑血管痉挛发生,改善脑脊液循环及脑血流灌注,有助于术后恢复。

Objective:To investigate the clinical efficacy of ultra-early continuous lumbar cistern drainage combined with clipping in the treatment of aneurysmal subarachnoid hemorrhage(aSAH).Methods:The clinical data of 136 patients with aSAH admitted to our hospital between January 2010 and January 2018 were retrospectively analyzed.According to the treatment methods,all patients were divided into the study group and control group(n=68 each).The study group underwent continuous lumbar cistern drainage combined with clipping,and the control group underwent simple microscopic craniotomy combined with clipping.All patients were followed up after the operation,and the clinical efficacy between the two groups was compared.Results:The comparison in short-term efficacy showed that cerebrospinal fluid pressure,middle cerebral artery(MCA)flow velocity,occurrence of cerebral vasospasm and Hunt-Hess grading in the study group were better than those in the control group at 3 and 7d after the operation(all P<0.05).The comparison in long-term efficacy showed that there were no statistically significant difference in Glasgow Coma Scale(GCS)scores between the two groups at 1 month after the operation(P>0.05).At 3 and 6 months after the operation,the Modified Rankin Scale(MRS)scores in the study group were lower than those in the control group(both P<0.05).Conclusion:Ultra-early continuous lumbar cistern drainage combined with clipping may reduce the occurrence of cerebral vasospasm in aSAH patients,improve cerebrospinal fluid circulation and cerebral blood perfusion,and favors postoperative recovery.