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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 预览

Effects of lumbar puncture and lumbar cistern drainage on shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage
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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.
作者 王能强 WANG Nengqiang(Chaonan Minsheng Hospital of Shantou,Shantou 515144,China)
出处 《包头医学院学报》 CAS 2019年第1期34-35,38共3页 Journal of Baotou Medical College
关键词 动脉瘤 蛛网膜下腔出血 脑脊液引流 Fisher分级 Aneurysm Subarachnoid hemorrhage Cerebrospinal fluid drainage Fisher grading
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