人工脑脊液脑池内冲洗防治蛛网膜下腔出血患者的脑血管痉挛  

Cisternal irrigation with artificial cerebrospinal fluid for the prevention and treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

作　　者：陆斌[1] 张宏义[1] 杨郁野[1] 李永秋[2] 毕堃 王跃伍 祁大勇[1] 

机构地区：[1]唐山工人医院神经外一科,063000 [2]唐山工人医院神经内科,063000

出　　处：《中国脑血管病杂志》2007年第11期491-495,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：河北省指令性科研基金项目(02276104D-16)

摘　　要：目的探讨应用人工脑脊液脑池内冲洗引流防治动脉瘤破裂后SAH导致的脑血管痉挛的治疗方法,以提高疗效,改善预后。方法对132例动脉瘤合并SAHFisherⅢ-Ⅳ级的患者,3d内急诊行动脉瘤夹闭术。脑池内冲洗组67例,夹闭术中视交叉池置入冲洗管,在外侧裂池置入引流管。夹闭术后开始进行人工脑脊液脑池内冲洗,腰椎穿刺组65例,夹闭术后腰椎穿刺引流血性脑脊液。夹闭术后动态监测脑脊液中红细胞数量的变化及行经颅多普勒（transcranial Doppler,TCD）监测脑血管痉挛的情况。结果两组患者夹闭术后脑脊液红细胞数均呈下降趋势,经t检验,第1天两组差异无统计学意义,第3天后脑池内冲洗组红细胞数均低于腰椎穿刺组,差异均有统计学意义,P〈0.01。两组症状性脑血管痉挛的发生率,脑池内冲洗组为4%,低于腰椎穿刺组的26%,P〈0.01;夹闭术后各时期TCD报告的脑血管痉挛发生率,脑池内冲洗组均低于腰椎穿刺组,P〈0.01。夹闭术后脑池内冲洗组偏瘫的发生率低于腰椎穿刺组,χ^2=8.335,P〈0.01。脑池内冲洗组较腰椎穿刺组SAH清除快,血管痉挛的发生率明显减少,致残率下降。结论急性期动脉瘤夹闭术后人工脑脊液脑池内冲洗防治脑血管痉挛的方法简单、安全,疗效显著。　Objective To investigate the therapeutic effects of cisternal irrigation with artificial cerebrospinal fluid for the prevention and treatment of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage for the purpose to improve the final prognosis of the patients.Methods Emergent aneurysm clipping was performed in 132 patients with acute aneurysmal subarachnoid hemorrhage （Fisher grade 3 to 4） within three days. The irrigating tubes were placed in the opticochiasmatic cisterns in 67 patients in the irrigation group, and the draining tubes were placed in the sylvian cistern during operation. Intracisternal irrigation with artificial cerebrospinal fluid started after operation. In the contral group, bloody cerebrospinal fluid was drained by lumber puncture in 65 patients after the operation. The number of erythrocytes in cerebrospinal fluid was calculated successively and cerebral vasospasm was mornitored by transcranial Doppler （TCD） after operation.Results The number of erythrocytes in cerebrospinal fluid had decreasing tendency in both groups after the surgery. There was no statistical difference between the two group by test at day 1. However, the number of erythrocytes in the irrigation group was lower than that of the control group after 3 days, and there was statistical significance between the two groups （P〈0.01）. The incidence of symptomatic vasospasm was 4% in the irrigation group, and it was lower than 26% in the control group （P〈0.01）. The incidence of cerebral vasospasm reported by TCD at different periods after the operation in the irrigation group was lower than that of the control group （P〈0.01）. The incidence of hemiplegia in the irrigation group was lower than that of the control group after the operation （χ2=8.335, P〈0.01）. As compared with the control group, subarachnoid blood was cleaned more rapidly in the irrigation group, the incidence of cerebral vasospasm and disability were decreased significantly.Conclusion The cisternal irrigation method for t

关 键 词：动脉瘤 蛛网膜下腔出血 血管痉挛 颅内 灌洗 

分 类 号：R743.35[医药卫生—神经病学与精神病学]