腰穿与腰大池引流对动脉瘤性蛛网膜下腔出血术后发生分流依赖性脑积水的影响
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摘要
目的:比较两种不同脑脊液引流方式对动脉瘤性蛛网膜下腔出血术后发生分流依赖性脑积水的影响。方法:选择2016年4月至2018年4月间收治的80例动脉瘤性蛛网膜下腔出血患者进行研究,按照患者接受脑脊液引流的不同方式进行分组,观察组40例接受腰穿引流治疗,对照组40例接受腰大池引流治疗,比较两组患者术后效果及分流依赖性脑积水的疗效。结果:两组患者的每日引流量、抗生素使用率、发热发生率均有差异(P<0.05),两组患者脑梗死、脑血管痉挛发生率差异无明显统计学意义(P>0.05);观察组患者的预后良好率为80.0%,对照组患者的预后良好率75.0%,观察组患者日常生活能力与对照组比较,差异无统计学意义(P>0.05)。80例患者中,19例患者术后发生脑积水,发生率为23.8%。Fisher分级Ⅲ～Ⅳ级中,两组患者术后分流依赖性脑积水的发生率有差异(P<0.05)。结论:动脉瘤性蛛网膜下腔出血接受腰大池引流可降低分流依赖性脑积水的发生率,但腰穿引流的抗生素使用率和发热发生率更低,临床医生应根据患者的Fisher分级采用个体化治疗策略。
Objective:To study the curative effect of different cerebrospinal fluid drainage on shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhag. Methods: Eighty patients with aneurysmal subarachnoid hemorrhage admitted from April 2016 to April 2008 were enrolled in this study. The patients were divided into groups according to different ways of cerebrospinal fluid drainage. 40 patients in the observation group underwent lumbar drainage. 40 patients in the control group underwent drainage from the lumbar cistern, and the postoperative results and the efficacy of shunt-dependent hydrocephalus were compared between the two groups. Results:There were significant differences in daily drainage, antibiotic use rate, and fever incidence between the two groups(P<0.05). There was no significant difference in the incidence of cerebral infarction and cerebral vasospasm between the two groups(P>0.05). The patients in the observation group had a good prognosis rate of 80.0 %, while those in the control group had a good prognosis rate of 75.0 %. There was no statistically significant difference in the ability of daily living between the observation group and the control group(P>0.05). Of the 80 patients, 19 had hydrocephalus after surgery, with an incidence of 23.8 %. There was a statistically significant difference in the incidence of postoperative shunt-dependent hydrocephalus between Fisher III and IV(P<0.05). Conclusion:Aneurysmal subarachnoid hemorrhage receiving lumbar drainage can reduce the incidence of shunt-dependent hydrocephalus, but the rate of antibiotic use and fever is lower in lumbar puncture drainage. Clinicians should adopt individualized therapeutic options according to the patients' Fisher grading.
Objective:To study the curative effect of different cerebrospinal fluid drainage on shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhag. Methods: Eighty patients with aneurysmal subarachnoid hemorrhage admitted from April 2016 to April 2008 were enrolled in this study. The patients were divided into groups according to different ways of cerebrospinal fluid drainage. 40 patients in the observation group underwent lumbar drainage. 40 patients in the control group underwent drainage from the lumbar cistern, and the postoperative results and the efficacy of shunt-dependent hydrocephalus were compared between the two groups. Results:There were significant differences in daily drainage, antibiotic use rate, and fever incidence between the two groups(P<0.05). There was no significant difference in the incidence of cerebral infarction and cerebral vasospasm between the two groups(P>0.05). The patients in the observation group had a good prognosis rate of 80.0 %, while those in the control group had a good prognosis rate of 75.0 %. There was no statistically significant difference in the ability of daily living between the observation group and the control group(P>0.05). Of the 80 patients, 19 had hydrocephalus after surgery, with an incidence of 23.8 %. There was a statistically significant difference in the incidence of postoperative shunt-dependent hydrocephalus between Fisher III and IV(P<0.05). Conclusion:Aneurysmal subarachnoid hemorrhage receiving lumbar drainage can reduce the incidence of shunt-dependent hydrocephalus, but the rate of antibiotic use and fever is lower in lumbar puncture drainage. Clinicians should adopt individualized therapeutic options according to the patients' Fisher grading.
引文
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[6] 刘炎,杭春华,茅磊,等.高分级动脉瘤性蛛网膜下腔出血颅内动脉瘤夹闭术后不同引流方式的疗效及对预后的影响[J].疑难病杂志,2017,16(6):623-626.
[7] 陈均昌,包陆君,卢家璋,等.腰大池置管脑脊液持续外引流术治疗外伤性蛛网膜下腔出血的疗效[J].中国现代药物应用,2017,11(9):43-44.
[8] 吴海滨,赵冬青,王科.质子磁共振波谱分析创伤性蛛网膜下腔出血腰大池持续引流患者脑代谢的变化[J].临床神经外科杂志,2016,13(2):114-117.
[2] 黄庆,胡艳龙,杨俊,等.血性脑脊液早期引流对重症动脉瘤性蛛网膜下腔出血患者预后的影响[J].浙江临床医学,2016,18(7):1227-1228.
[3] 魏健强,李健,马剑.动脉瘤性蛛网膜下腔出血腰大池持续引流后慢性分流依赖性脑积水影响的调查研究[J].中西医结合心脑血管病杂志,2017,15(21):2763-2766.
[4] 汤维力.持续腰大池引流与多次腰椎穿刺术引流治疗重型颅脑损伤合并蛛网膜下腔出血的临床比较[J].中外医学研究,2016,14(13):22-24.
[5] 黄保胜,王天路,李帅,等.开颅夹闭治疗动脉瘤性蛛网膜下腔出血的疗效及脑室外引流对患者转归的影响[J] 江苏医药,2016,42(23):2543-2546.
[6] 刘炎,杭春华,茅磊,等.高分级动脉瘤性蛛网膜下腔出血颅内动脉瘤夹闭术后不同引流方式的疗效及对预后的影响[J].疑难病杂志,2017,16(6):623-626.
[7] 陈均昌,包陆君,卢家璋,等.腰大池置管脑脊液持续外引流术治疗外伤性蛛网膜下腔出血的疗效[J].中国现代药物应用,2017,11(9):43-44.
[8] 吴海滨,赵冬青,王科.质子磁共振波谱分析创伤性蛛网膜下腔出血腰大池持续引流患者脑代谢的变化[J].临床神经外科杂志,2016,13(2):114-117.