脑脊液置换治疗继发性蛛网膜下腔出血84例疗效观察

Cerebrospinal fluid replacement in secondary subarachmoid hemorrhage

目的 :观察脑脊液置换治疗继发性蛛网膜下腔出血 (SSAH)的疗效。方法 :将 16 9例SSAH患者随机分为治疗组 (脑脊液置换治疗组 ) 84例与对照组 (常规药物治疗组 ) 85例 ,对其治疗结果进行比较。结果 :治疗组脑积水的发生率、血肿的吸收时间均显著低于对照组 [(7.1%vs2 9.4 % ) ;(18± 8)dvs(2 7± 9)d ,P <0 .0 1];治疗 35d后神经功能缺损评分值显著优于对照组 [(3.4± 4 .0 )分vs (13.9± 4 .3)分 ,P <0 .0 1];总有效率明显高于对照组 (90 .5 %vs 6 5 .9% ,χ2 =9.15 ,P <0 .0 1) ;病死率显著低于对照组 (4 .8%vs 14 .1% ,χ2 =4 .314 ,P <0 .0 5 ) ;治疗组患者的预后明显优于对照组 (Hc =19.5 ,P <0 .0 0 1)。结论 :脑脊液置换治疗可促进SSAH患者脑内血肿的吸收和神经功能的恢复 ,降低脑积水的发生率和病死率 。

Objective:To observe the efficacy of cerebrospinal fluid(CSF) replacement in secondary subarachmoid hemorrhage(SSAH).Methods:A total of 169 patients with SSAH were randomly allotted to two groups:treatment group ( n =84) underwent conventional treatment plus CSF replacement,and control group ( n =85) only received conventional treatment.Patients were followed up for 35 days after management.Results:Incidence of hydrocephalus,intracerebral hematoma absorption time and hyponeuria score in treatment group were significantly lower than those in control group [7.1% vs 29.4%, P< 0.01;(18±8)d vs (27±9)d, P< 0.01;(3.4±4) vs (13.9±4.3), P< 0.01)].Compared with control group,there were a good efficacy (90.5% vs 65.9%, P< 0.01),and prognosis ( Hc =19.5, P< 0.001), and a low mortality (4.8% vs 14.1%, P< 0.05) in treatment group.Conclusion:CSF replacement results in an obvious improvement of prognosis in patients with SSAH via promoting the intracerebral hematoma absorption and the restoration of nervous function and lowering the frequency of hydrocephalus and mortality.