目的 探讨动脉瘤性蛛网膜下腔出血(aSAH)介入治疗后早期行脑室外引流 (EVD)联合腰大池引流(LD)的应用效果。方法 选取武警特色医学中心2020-02至2023-02收治的80例aSAH患者,随机分为联合治疗组和对照组,每组40例。两组均行血管介入治疗,24 h内联合治疗组进行EVD联合LD治疗,对照组进行LD治疗;两组均给予常规抗血管痉挛及对症支持治疗。比较引流第1、3、5天两组LD脑脊液中血红蛋白含量、患侧大脑中动脉血流速度。对比两组患者并发症(脑血管痉挛、迟发性脑梗死及脑积水)发生率及出院时国际格拉斯哥预后(GOS)评分。结果 引流第3天及第5天,联合治疗组患者LD脑脊液中血红蛋白量明显低于对照组,差异具有统计学意义(P<0.05)。引流第5天联合治疗组大脑中动脉平均流速[(101.4±6.2)cm/s]低于对照组[(118.5±7.5)cm/s],差异具有统计学意义(P<0.05)。联合治疗组脑血管痉挛、迟发性脑梗死及脑积水等并发症的发生率均低于对照组,差异具有统计学意义(P<0.05)。联合治疗组出院时GOS评分[(4.32±0.69)分]高于对照组[(3.98±0.73)分],具有统计学差异(P<0.05)。结论 LD联合EVD可加快aSAH患者脑脊液中血液的清除,降低脑血管痉挛、迟发性脑梗死及脑积水等并发症的发生率,改善患者整体预后。
Abstract
Objective To explore the clinical effect of early external ventricular drainage (EVD) combined with lumbar cistern drainage (LD) after interventional treatment of aneurysmal subarachnoid hemorrhage (aSAH).Methods Eighty patients with aSAH admitted from February 2020 to February 2023 were randomly divided into an experimental group and a control group after vascular intervention treatment. EVD and LD were performed in the test group within 24 hours, and LD was performed in the control group. The patients in both groups were given routine anti vasospasm and symptomatic support treatment. The hemoglobin content in cerebrospinal fluid and the blood flow velocity of the affected side of the middle cerebral artery between the two groups on the 1st, 3rd, and 5th day of drainage were compared. The incidence of complications (cerebral vasospasm, delayed cerebral infarction and Hydrocephalus) and the International Glasgow Outcome Score (GOS) at discharge were also compared.Results On the 3rd and 5th day of drainage, the hemoglobin levels in LD cerebrospinal fluid of patients in the combined treatment group were significantly lower than those in the control group, and the difference was statistically significant (P<0.05). On the third day of drainage, the total amount of cerebrospinal fluid hemoglobin in the drainage fluid of the experimental group was higher than that of the control group, with a statistical difference (P<0.05). On the 5th day of drainage, the average flow velocity of the middle cerebral artery in the experimental group [(101.4±6.2)cm/s]was lower than that in the control group [(118.5±7.5)cm/s], with a statistical difference (P<0.05). The incidence of cerebral vasospasm, delayed cerebral infarction, hydrocephalus and other complications in the test group were lower than those in the control group (P<0.05). The GOS score of the experimental group at discharge [(4.32±0.69) points] was higher than that of the control group [(3.98±0.73) points], with a statistical difference (P<0.05).Conclusions LD combined with EVD can accelerate the clearance of blood in cerebrospinal fluid of patients with aSAH, reduce the incidence of complications such as cerebral vasospasm, delayed cerebral infarction and Hydrocephalus, and improve the overall prognosis of patients.
关键词
动脉瘤性蛛网膜下腔出血 /
腰大池引流 /
脑室外引流 /
脑血管痉挛 /
迟发性脑梗死
Key words
aneurysmal subarachnoid hemorrhage /
lumbar cistern drainage /
external ventricular drainage /
cerebral vasospasm /
delayed cerebral infarction
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