侧脑室穿刺联合腰大池置管脑脊液双向引流术治疗重症蛛网膜下腔出血的研究(1)
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【摘要】目的 评价贾氏微创法侧脑室穿刺联合腰大池置管脑脊液双向持续外引流术治疗介入栓塞后重症动脉瘤性蛛网膜下腔出血的疗效。方法 对41例重症动脉瘤性蛛网膜下腔出血患者在动脉瘤介入栓塞后分别行单纯腰大池置管引流及贾氏微创法侧脑室穿刺联合腰大池置管脑脊液双向持续外引流术治疗，对比两种疗法治疗患者的死亡率、头痛消失时间、脑膜刺激征消失时间、意识障碍消失时间。结果 联合治疗组患者死亡率、头痛消失时间、脑膜刺激征消失时间、意识障碍消失时间均与单纯腰大池置管引流组存在显著性差异。结论 贾氏微创法侧脑室穿刺联合腰大池置管脑脊液双向持续外引流术治疗介入栓塞后重症动脉瘤性蛛网膜下腔出血简单易行，疗效确切，安全可靠，值得在临床推广。
【关键词】蛛网膜下腔出血 侧脑室穿刺引流术 腰大池置管引流术
中图分类号：R651.1 文献标识码：A 文章编号：1005-0515(2012)3-008-02
Controlled study of continuous drainage of cerebrospinal fluid (CSF) by lateral ventricle puncture combined with lumber cistern catheterization in the treatment of serious aneurismal subarachnoid hemorrhage after interventional emblization
Jian Hongbin
(People’s Hospital of Xinxing county，Xinxing Guangdong 527400, China)
【Abstract】Objective To study the effect of the continuous CSF drainage by lateral ventricle puncture with micro-invasion and lumber cistern catheterization on the patients suffering from serious aneurismal subarachnoid hemorrhage. Methods 41 cases of serious aneurismal subarachnoid hemorrhage was randomized applied with either lumber cistern catheterization only or lateral ventricle puncture and lumber cistern catheterization for continuous CSF drainage,besides regular medicine treatments,and the mortality, headache disappearance time, meningeal irritation disappearance time, disturbance of consciousness disappearance time of hydrocephalus and incidence of infection was compared. Results there are significance differences between two groups as for the mortality, headache disappearance time, meningeal irritation disappearance time, disturbance of consciousness disappearance time. Conclusions The combined therapeutic method is easy to operate, efficient and safe for the therapy of serious neurismal subarachnoid hemorrhage, and it is worth spreading in clinic.
【Key words】Subarachnoid hemorrhage Continuous CSF drainage by lateral ventricle puncture; Continuous CSF drainage by lumber cistern catheterization
蛛网膜下腔出血(subarachnoid hemorrhage,SAH) 是脑血管疾病中的重症之一，尤其是重症蛛网膜下腔出血，其病情凶险、死亡率高，腰大池置管脑脊液引流术对于动脉瘤性蛛网膜下腔出血患者的良好治疗效果已得到广泛的理论及临床实践证明。而对于重症动脉瘤性蛛网膜下腔出血患者，大部分合并有脑室系统内的积血，单纯依靠腰大池置管引流难以尽快彻底清除。侧脑室穿刺合并腰大池置管脑脊液双向持续外引流术能更快、更彻底地清除蛛网膜下腔及脑室系统的积血，在文献中已有报道。但其疗效是否优于单纯腰大池置管引流，是否增加感染率，国内并无相关对照研究，我院自2009年1月～2011年12月间对60例介入栓塞术后重症动脉瘤性蛛网膜下腔出血(Hunt-Hess分级3～5级)的患者进行了单纯腰大池置管引流及腰大池引流联合贾氏微创法侧脑室穿刺脑脊液双向引流术治疗的随机对照研究，以比较两种疗法的临床价值 ......
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