腰大池持续稳压外引流在动脉瘤破裂患者围手术期的临床应用  

Clinical application of the persistent stable lumbar cistern drainage on the perioperative patients with ruputred aneurysm

作　　者：郑慧军[1] 常金生[1] 常枫[1] 张天祥[1] 

机构地区：[1]河南省安阳市人民医院神经外科,455000

出　　处：《中华脑科疾病与康复杂志（电子版）》2012年第2期114-117,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的评价腰大池持续稳压外引流在动脉瘤破裂患者围手术期的治疗效果。方法收集2010年8月至2011年8月急诊入河南省安阳市人民医院的动脉瘤破裂患者共60例,随机分成腰大池持续稳压外引流组(试验组)和传统腰椎穿刺释放血性脑脊液组(治疗组)各30例。对比分析围手术期行腰大池持续稳压外引流治疗与同期行传统常规腰椎穿刺引流治疗患者的临床资料(脑积水发生率、二次手术去骨瓣减压率、脑脊液引流量、术后三个月门诊或电话随访恢复结果)并分别采用χ2检验和t检验。结果随访3个月,30例持续稳压外引流组患者脑积水1例(3.3%);二期去骨瓣减压2例(6.7%);生活完全自理26例(86.7%),生活部分或不能自理4例(13.3%)。传统腰椎穿刺引流组中脑积水6例(20.0%);二期行去骨瓣减压6例(20.0%);生活完全自理20例(66.7%);生活部分或不能自理8例(26.7%);死亡2例(6.7%)。两组平均总引流量[分别为(1220±712)ml、(260±200)ml]、术后第7天脑脊液蛋白[分别为(770±212)mg/L、(1520±463)mg/L]、红细胞计数[分别为(410±108)×106/L、(1210±263)×106/L]差异均有统计学意义(t=3.112、4.965、3.087,P<0.05)。结论持续腰大池外引流在动脉瘤围手术期的使用简便易行,可提高治愈率,改善预后,建议推广应用。Objective To evaluate the therapeutical effect of persistent stable lumbar cistern drainage on the perioperative patients with ruputred aneurysm.Methods A total of 60 patients with ruptured aneurysm in People Hospital of Anyang city from August 2010 to August 2011 were randomly divided into the lumbar cistern drainage group(experiment group,n=30)and conventional lumbar puncture drainage group(treatment group,n=30).The patients clinical data(including hydrocephalus incidence,bone flap secondary decompression rate,cerebrospinal fluid flow and recovery results after three months,followed-up by clinic or telephone.The data was dealed with χ2test or t test respectively)were compared between persistent stable lumbar cistern drainage and conventional lumbar puncture drainage in the same peroid.Results Thirty cases who used persistent stable lumbar cistern drainage were followed up for three months,1 case(3.3%)occurred hydrocephalus and 2 cases(6.6%)accepted bone flap secondary decompression,26 cases(86.7%)had daily life,and 4 cases(13.3%)could not take care of daily life.In the control group,6 cases(20%)occurred hydrocephalus,6 cases(20%)accepted bone flap secondary decompression,20 cases(66.7%)had daily life,8 cases(26.7%)could not take care of daily life and 2 cases(6.7%)died.The differences of total drainage volume [(1220 ± 712)ml and(260 ± 200)ml respectively],the cerebrospinal fluid protein[(770 ±212)mg/L and(1520 ±463)mg/L respectively]and red blood cell count [(410 ± 108)× 106/ L and(1210 ± 263)× 106/ L respectively] at 7th after surgery were statistically significant(t=3.112,4.965,3.087,P<0.05).Conclusion The therapeutical method of the persistent stable lumbar cistern drainage on the perioperative patients with ruputred aneurysm can increase the cure rate,and improve the prognosis.

关 键 词：动脉瘤 蛛网膜下腔出血 引流术 

分 类 号：R651.1[医药卫生—外科学]