腰大池持续外引流术在创伤性蛛网膜下腔出血中的应用效果观察
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摘要
目的探讨腰大池持续外引流术在创伤性蛛网膜下腔出血中的应用效果。方法将50例创伤性蛛网膜下腔出血患者按随机数字表法分为对照组和观察组,每组25例。对照组行腰椎穿刺术治疗,观察组行腰大池持续外引流术治疗。观察比较两组患者在不同时间段脑CT灌注成像的脑血容量(CBV)、脑血流量(CBF)、对比剂达峰时间(TTP)、对比剂平均通过时间(MTT)的参数变化以及脑脊液内皮素-1(ET-1)、一氧化氮(NO)水平。结果治疗后第7天、第14天,观察组CBV、CBF、NO水平明显高于对照组,TTP、MTT、ET-1水平明显低于对照组,差异有统计学意义(P=0.000)。结论创伤性蛛网膜下腔出血会诱发脑血管痉挛,腰大池持续外引流术能快速廓清血性脑脊液,缓解脑血管痉挛,改善脑血流灌注,改善患者预后。
Objective To investigate the effect of continuous lumbar drainage on traumatic subarachnoid hemorrhage.Methods Fifty patients with traumatic subarachnoid hemorrhage were divided the control group and observation group by random number table method,25 cases in each group.The control group received lumbar puncture treatment,and the observation group was treated with continuous lumbar drainage.The parameters of cerebral blood volnine(CBV),cerebral blood flow(CBF),time to peak(TTP),mean transit time(MTT) in cerebral computed tomography(CT) perfusion imaging at different time points and the levels of endothelin-1(ET-1),nitric oxidex(NO)in the cerebrospinal fluid were compared between the two groups.Results The parameters of CBV,CBF and NO in the observation group were obviously higher than those in the control group 7 and 14 days after treatment.The levels of TTP,MTT,ET-1 in the observation group were obviously lower than those in the control group 7 and 14 days after treatment(P=0.000).Conclusion Traumatic subarachnoid hemorrhage can induce cerebral vasospasm,and the continuous lumbar drainage can quickly remove the hemorrhagic cerebrospinal fluid to relieve the cerebral vasospasm,and improve cerebral blood perfusion and the prognosis of the patients.
Objective To investigate the effect of continuous lumbar drainage on traumatic subarachnoid hemorrhage.Methods Fifty patients with traumatic subarachnoid hemorrhage were divided the control group and observation group by random number table method,25 cases in each group.The control group received lumbar puncture treatment,and the observation group was treated with continuous lumbar drainage.The parameters of cerebral blood volnine(CBV),cerebral blood flow(CBF),time to peak(TTP),mean transit time(MTT) in cerebral computed tomography(CT) perfusion imaging at different time points and the levels of endothelin-1(ET-1),nitric oxidex(NO)in the cerebrospinal fluid were compared between the two groups.Results The parameters of CBV,CBF and NO in the observation group were obviously higher than those in the control group 7 and 14 days after treatment.The levels of TTP,MTT,ET-1 in the observation group were obviously lower than those in the control group 7 and 14 days after treatment(P=0.000).Conclusion Traumatic subarachnoid hemorrhage can induce cerebral vasospasm,and the continuous lumbar drainage can quickly remove the hemorrhagic cerebrospinal fluid to relieve the cerebral vasospasm,and improve cerebral blood perfusion and the prognosis of the patients.
引文
1魏大伟,刘家传,杨艳艳,等.腰大池持续引流治疗创伤性蛛网膜下腔出血的临床分析[J].临床神经外科杂志,2015,12(4):245-247.
2李光亮,赵向南,王方艺.创伤性蛛网膜下腔出血继发脑积水的临床分析[J].中国临床神经外科杂志,2016,21(7):433-434.
3张月清,王福林,何二平.深静脉导管在腰大池持续引流术中的应用[J].中国临床神经外科杂志,2017,22(3):184-185.
4 Morris NA,Cool J,Merkler AE,et al.Subarachnoid hemorrhage and long-term stroke risk after traumatic brain injury[J].Neurohospitalist,2017,7(3):122-126.
5周正山,高伟,谭宪军,等.腰大池持续外引流术与腰椎穿刺释放脑脊液治疗创伤性蛛网膜下腔出血的临床对比研究[J].实用临床医药杂志,2016,20(1):96-97.
6李志峰,陈勇,方红娟,等.腰大池持续引流治疗外伤性蛛网膜下腔出血的系统评价[J].北京医学,2017,39(1):26-30.
7邱华辉.盐酸法舒地尔联合尼莫地平治疗脑外伤性蛛网膜下腔出血患者的临床研究[J].中国临床药理学杂志,2016,32(17):1553-1556.
8惠军,李宝明,左毅,等.腰大池引流术在创伤性蛛网膜下腔出血治疗中的应用[J].陕西医学杂志,2015,44(10):1317-1319.
9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.
10郎胜坤,马铁柱,郝芊芊,等.CTA联合CTP对蛛网膜下腔出血所致脑血管痉挛与迟发性脑缺血的相关性探讨[J].中西医结合心脑血管病杂志,2017,15(2):155-157.
11 Takeuchi S,Mori K,Arimoto H,et al.Effects of intravenous infusion of hydrogen-rich fluid combined with intra-cistrnal infusion of magnesium sulfate in severe aneurysmal subarachnoid hemorrhage:study protocol for a randomized controlled trial[J].BMC Neurol,2014,14(1):176.
12徐东勋,伍雪英,杨友松.尼莫地平联合帕伐他汀预防蛛网膜下腔出血后脑血管痉挛的效果观察及对内皮素-1、一氧化氮的影响[J].实用医院临床杂志,2016,13(3):48-50.
13曾家良,谢飞,叶永强,等.腰大池引流术对外伤性蛛网膜下腔出血患者脑脊液NO、ET-1水平的影响[J].中国临床神经外科杂志,2017,22(3):162-164.
2李光亮,赵向南,王方艺.创伤性蛛网膜下腔出血继发脑积水的临床分析[J].中国临床神经外科杂志,2016,21(7):433-434.
3张月清,王福林,何二平.深静脉导管在腰大池持续引流术中的应用[J].中国临床神经外科杂志,2017,22(3):184-185.
4 Morris NA,Cool J,Merkler AE,et al.Subarachnoid hemorrhage and long-term stroke risk after traumatic brain injury[J].Neurohospitalist,2017,7(3):122-126.
5周正山,高伟,谭宪军,等.腰大池持续外引流术与腰椎穿刺释放脑脊液治疗创伤性蛛网膜下腔出血的临床对比研究[J].实用临床医药杂志,2016,20(1):96-97.
6李志峰,陈勇,方红娟,等.腰大池持续引流治疗外伤性蛛网膜下腔出血的系统评价[J].北京医学,2017,39(1):26-30.
7邱华辉.盐酸法舒地尔联合尼莫地平治疗脑外伤性蛛网膜下腔出血患者的临床研究[J].中国临床药理学杂志,2016,32(17):1553-1556.
8惠军,李宝明,左毅,等.腰大池引流术在创伤性蛛网膜下腔出血治疗中的应用[J].陕西医学杂志,2015,44(10):1317-1319.
9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.
10郎胜坤,马铁柱,郝芊芊,等.CTA联合CTP对蛛网膜下腔出血所致脑血管痉挛与迟发性脑缺血的相关性探讨[J].中西医结合心脑血管病杂志,2017,15(2):155-157.
11 Takeuchi S,Mori K,Arimoto H,et al.Effects of intravenous infusion of hydrogen-rich fluid combined with intra-cistrnal infusion of magnesium sulfate in severe aneurysmal subarachnoid hemorrhage:study protocol for a randomized controlled trial[J].BMC Neurol,2014,14(1):176.
12徐东勋,伍雪英,杨友松.尼莫地平联合帕伐他汀预防蛛网膜下腔出血后脑血管痉挛的效果观察及对内皮素-1、一氧化氮的影响[J].实用医院临床杂志,2016,13(3):48-50.
13曾家良,谢飞,叶永强,等.腰大池引流术对外伤性蛛网膜下腔出血患者脑脊液NO、ET-1水平的影响[J].中国临床神经外科杂志,2017,22(3):162-164.