早期腰大池引流与腰椎穿刺脑脊液置换对蛛网膜下腔出血患者血管痉挛的影响

Effect of early continuous lumbar drainage or lumbar puncture cerebrospinal fluid replacement on vasospasm in patients with subarachnoid hemorrhage

目的探讨早期两种不同脑脊液置换术对蛛网膜下腔出血(SAH)患者血管痉挛的影响。方法选取2014年1月至2015年6月于我院神经内科住院治疗的96例SAH患者,按随机数表法分为两组,每组48例。A组于出血后24 h内实施腰大池持续引流术,B组出血后24 h内实施腰椎穿刺脑脊液置换术,术后记录两组患者的脑脊液廓清及症状缓解时间,观察血管痉挛发生及并发症发生情况。结果 A组患者的脑脊液廓清时间为(6.53±0.86)d,明显短于B组的(7.68±0.91)d,差异有统计学意义(P<0.05);两组患者的头痛缓解、脑膜刺激症消失时间比较差异均无统计学意义(P>0.05);A组术后30 d内血管痉挛发生率为12.50%,明显低于B组的29.17%,差异有统计学意义(P<0.05);两组患者术后1 d、30 d的大脑中动脉平均流速(MCAVm)、Lingdegaard指数比较差异均无统计学意义(P>0.05),但术后7 d、15 d A组患者的MCAVm分别为(98.82±18.44)、(93.12±11.27),Lingdegaard指数分别为(1.70±0.38)、(1.52±0.34),B组则分别为(115.76±19.70)、(106.23±13.87)、(1.88±0.41)、(1.68±0.37),差异均有统计学意义(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05)。结论两种脑脊液置换术均能有效缓解SAH患者症状,并发症发生率相当,但腰大池引流对早期血管痉挛的防治作用优于腰椎穿刺脑脊液置换术。

Objective To investigate the effects of two different kinds of cerebrospinal fluid replacement on vasospasm in patients with subarachnoid hemorrhage(SAH). Methods Ninety-six patients with SAH treated in Department of Neurology in our hospital from Jan. 2014 to Jun. 2015 were selected and randomly divided into two groups(Group A and Group B), with 48 patients in each group. Group A applied continuous lumbar drainage within 24 h after hemorrhage, while Group B applied lumbar puncture cerebrospinal fluid replacement within 24 h after hemorrhage. Cerebrospinal fluid clearance and symptom relief time were recorded in two groups, and the occurrence of vasospasm and the complications were observed. Results The cerebrospinal fluid clearance time in Group A was significantly shorter than that in Group B [(6.53±0.86) d vs(7.68±0.91) d, P<0.05]. There were no significant differences in the duration of headache relief and meningeal irritation disappearance time between the two groups(P>0.05). The incidence of vasospasm within 30 d in Group A was significantly lower than that in Group B(12.50% vs 29.17%, P<0.05). There were no significant differences in the mean velocity of middle cerebral artery(MCAVm) and Lingdegaard index at 1 d, 30 d after operation between the two groups(P>0.05), but the MCAVm and Lingdegaard index at postoperative 7 d, 15 d in Group A [(98.82 ± 18.44),(93.12 ± 11.27) and(1.70 ± 0.38),(1.52 ± 0.34)] were significantly lower than those in Group B[(115.76±19.70),(106.23±13.87) and(1.88±0.41),(1.68±0.37), P<0.05]. There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion Two kinds of cerebrospinal fluid replacement can both effectively alleviate the symptoms of SAH patients, and the incidence of complications is equivalent. However,the prevention and treatment of early vascular spasm by continuous lumbar drainage is better than that of lumbar puncture cerebrospinal fluid replacement.