摘要
目的 观察腰大池置管持续引流防治动脉瘤性蛛网膜下腔出血并发脑积水的效果。方法 选取2013年5月至2015年4月 我院收治的动脉瘤性蛛网膜下腔出血(SAH)患者88例为研究对象,采用随机数表法分为观察组和对照组各44例,对 照组术后行腰穿刺引流,观察组术后实施腰大池持续引流,对比两组治疗总有效率,同时记录其治疗前后脑血流 速度(Vm)、疼痛视觉模拟评分(VAS)、格拉斯哥评分(GOS),并观察术后脑积水、脑血管痉挛等并发症发生率。结 果 观察组治疗有效率81.82%明显高于对照组61.36%(P<0.05);观察组治疗后Vm(129.35±1.74)cm/s、VAS评分 (3.26±1.29)分均低于对照组(P<0.05),GOS评分(4.39±0.14)分高于对照组(P<0.05);观察组术后脑积水、脑血 管痉挛发生率(9.09%、15.91%)较对照组(27.27%、36.36%)低(P<0.05)。结论 腰大池置管持续引流对动脉瘤性 蛛网膜下腔出血治疗效果优于腰椎穿刺引流,同时可有效防治脑积水等并发症,值得在临床推广开应用。
Objective To observe the effect of continuous lumbar cisterna drainage in the treatment of hydrocephalus caused by aneurysmal subarachnoid hemorrhage. Methods A total of 88 patients with aneurysmal subarachnoid hemorrhage(SAH) from May 2013 to April 2015 in our hospital were taken as the clinical research objects, and they were divided into observation group (44 cases) and control group (44 cases) randomly. Patients in the control group were given lumbar puncture drainage, the other patients in the observation group were given continuous lumbar cisterna drainage. The cerebral blood flow velocity (Vm),visual analogue pain scale (VAS) and Glasgow score (GOS) before and after treatment were recorded, the postoperative complications as hydrocephalus and cerebral vasospasm were observed, and the total effective rates in the two groups were compared. Results The total effective rate in the observation group was 81.82% which was significantly higher than that in the control group 61.36%(P<0.05). The Vm and VAS in the observationgroup were respectively (129.35±1.74)cm/s and (3.26±1.29) which were lower than those in the control group(P<0.05). The GOS in the observation group was (4.39±0.14) which was significantly higher than that in the control group (P<0.05). The incidence rates of postoperative hydrocephalus and cerebral vasospasm in the observation group were respectively 9.09% and 15.91% which were lower than those in the control group 27.27% and 36.36%(P<0.05). Conclusion Continuous lumbar cisterna drainage, has better effect in the treatment of aneurysmal subarachnoid hemorrhage, and can effectively prevent hydrocephalus and other complications. Thus, it is worthy of clinical application.
【关键词】腰大池置管持续引流;动脉瘤性蛛网膜下腔出血;脑积水
【中图分类号】R619;R681.5
【文献标识码】A
【DOI】10.3969/j.issn.1009-3257.2017.04.013
前言
蛛网膜下腔出血占全部脑卒中5%~10%,其中85% 出血原因为颅内动脉瘤破裂,即动脉瘤性蛛网膜下腔 出血,蛛网膜下腔出血导致的脑积水及迟发性脑血管 痉挛等并发症为颅内动脉瘤患者致死、致残的主要原 因[1-3]。腰大池置管持续引流术可将蛛网膜下腔的血 性脑脊液引流出来,并通过脑脊液自然循环途径加速 蛛网膜下腔出血的清除,促进脑脊液分泌与循环,降低脑脊液浓度,而其安全性在临床备受争议[4]。本文 选取我院收治的动脉瘤性蛛网膜下腔出血患者88例为 研究对象,观察腰大池置管持续引流术防治其发生脑 积水的效果,现报告如下。
罕少疾病杂志
第24卷, 第 4 期
2019年11月
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