腰池持续引流治疗重度外伤性蛛网膜下腔出血的临床研究

Clinical study of continuous lumbar cistern drainage in patients with severe traumatic subarachnoid hemorrhage

目的 探讨腰池持续引流对重度外伤性蛛网膜下腔出血 (t SAH)的治疗效果。方法 对照组 78例 ,行腰穿放液 ;治疗组 6 9例 ,行腰池脑脊液 (CSF)持续引流。结果 对照组和治疗组患者 CSF中红细胞 (RBC) <1 0 0×1 0 6 / L 的时间分别为伤后 (9.0± 3.5 ) d和 (5 .7± 2 .4 ) d(P<0 .0 0 1 ) ,两组 CSF中总蛋白 (TP) <0 .8g/ L 时间分别为伤后 (1 2 .1± 4 .1 ) d和 (8.9± 3.1 ) d(P<0 .0 0 1 ) ,治疗组伤后平均颅内压 (ICP)、甘露醇用量显著低于对照组 ,治疗组头痛、脑膜刺激征持续时间短 ,脑积水及脑梗塞发生率、病死率均显著低于对照组。结论 腰池持续引流可快速廓清重度 t SAH患者的 CSF,患者并发症明显减少 。

Objective To study the effect of continuous lumbar cistern drainage of cerebrospinal fluid(CSF) on patients with severe traumatic subarachnoid hemorrhage(tSAH).Methods A total of 147 patients with severe tSAH were randomly devided into control group(n=78) and treatment group(n=69).The control group underwent a procedure for lumbar puncture and the treatment group underwent continuous lumbar cistern drainage.Results Time of red blood cells(RBC) was 9.0±3.5 days in CSF(<100×10 6/L) and 5.7±2.4 days in control group and treatment group respectively( P <0.001),time of total protein(TP) in CSF(<0.8 g/L) was 12.1±4.1 days and 8.9±3.1 days respectively( P <0.001).Comparing with control group,the average intracranial pressure(ICP) and amount of mannitol usage was remarkably lower in treatment group.In treatment group,headache and neck rigidity restored quickly.Conclusion By quickly clearing up CSF in patients with severe tSAH,continuous lumbar cistern drainage may relieve promptly patient's clinical symptoms,decline notably the complications and mortality.