两种方法预防蛛网膜下腔出血并发症疗效.doc

两种方法预防蛛网膜下腔出血并发症疗效[摘要] 目的 对比两种脑脊液引流方法对预防动脉瘤蛛网膜下腔出血后并发症的效果。方法 回顾分析本院97例动脉瘤蛛网膜下腔出血患者，其中34例采用术中侧裂池置管经皮持续外引流脑脊液，63例采用术后持续腰穿置换脑脊液，均接受常规治疗，随访其并发症发生率，时间大于6个月。结果 在观察病例中，外侧裂置管持续外引流者其脑积水和血管痉挛等并发症的发生率明显低于腰穿脑脊液置换组，差异具有显著性（P＜0.05）。结论 外侧裂置管持续脑脊液引流对蛛网膜下腔出血并发症的预防具有较好的疗效。 [关键词] 蛛网膜下腔出血；并发症；外侧裂置管脑脊液引流 [中图分类号] R743.35 [文献标识码] B[文章编号] 1673-9701（2011）25-151-02 The Efficacy between Lateral Fissure Drainage and Cerebrospinal Fluid Displacement to Prevent Complications after Subarachnoid Hemorrhage MAO Kangcheng1XIE Yun2 1.Department of Neurosurgery，People’s Hospital of Guanyun County，Guanyun 222200，China；2.Department of Neurosurgery，Anting Hospital of Jiading District，Shanghai 201805，China [Abstract] Objective To analyze the efficacy for preventing complications after SAH by two methods of cerebrospinal fluid drainage. Methods All 97 patients with subarachnoid hemorrhage were reviewed，34 patients were treated with lateral fissure drainage，63 patients with cerebrospinal fluid replacement，and all received conventional treatment. The incidence of complications were observed follow-up time greater than 6 months. Results Those with lateral fissure drainage had a low incidence of complications such as vasospasm and hydrocephalus. It showed an obvious statistical significance（P＜0.05）. Conclusion Lateral fissure drainage for the prevention of complications after SAH is efficitive. [Key words] Subarachnoid hemorrhage；Complications；Lateral fissure cerebrospinal fluid drainage 动脉瘤破裂蛛网膜下腔出血（subaraehnoid hemorrhage，SAH）是一种急性脑血管疾病，致死致残率高，其血液流入蛛网膜下腔后引起脑血管痉挛、脑积水等并发症，采用外在方法加快血液的清除，能显著减少并发症的发生率[1,2]。回顾我科2008年1月～2010年12月收治的SAH患者97例，34例采用了术中侧裂池置管经皮持续外引流脑脊液，取得了满意的效果，现报道如下。 1资料与方法 1.1一般资料 所有病例均经头颅CT及腰穿诊断明确。其中男40例，女57例；年龄19～73岁，平均42岁；均在发病24h内入院；经DSA检查明确诊断且均接受手术夹闭，其中前交通动脉瘤22例，中动脉瘤24例，后交通动脉瘤34例，其他部位动脉瘤17例，两组病例Hunt-Hess分级及Fish评分统计学具有可比性。 1.2治疗方法 全部病例均手术后入住监护病房，绝对卧床休息，保持安静，保持大便通畅，密切监护神志、瞳孔及生命体征的变化，予吸氧、解痉、补液等常规治疗，辅以神经营养药物。置管组予以持续外引流，根据颅内压情况调整高度，控制颅内压不超过20mmHg，引流量不超过150mL/d，至引流液