侧脑室穿刺引流对自发性蛛网膜下腔出血介入治疗患者术后并发症的影响  

The effects of lateral ventricle puncture drainage on complications of patients with spontaneous subarachnoid hemorrhage who receive interventional therapy

作　　者：王延民[1,2] 马铁柱[1] 涂悦[1,2] 赵明亮[1] 张赛[1] 

机构地区：[1]武警后勤学院附属医院脑系科中心,天津300162 [2]天津中医药大学,天津300193

出　　处：《中国中西医结合急救杂志》2012年第6期330-332,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目（30872668）

摘　　要：目的研究早期侧脑室穿刺引流和颅内压监护对Hunt-Hess分级Ⅱ-Ⅲ级自发性蛛网膜下腔出血（SAH）患者并发症的影响。方法采用前瞻性研究方法，将60例自发性SAH患者按随机原则分为研究组和对照组两组，每组30例。所有患者入院后均行全脑血管造影检查，阳性者给予血管内介入治疗，术后均给予腰大池置管引流、止血及预防血管痉挛等常规治疗。研究组在常规治疗基础上行侧脑室穿刺引流术及颅内压监护。发病后7d及14d分别观察患者脑电图（EEC）情况以及脑梗死和脑积水的发生率。结果两组患者EEC以皮质普遍性改变为主，表现为阵发性中至高幅慢波，分级越重，出现慢波的频率越多，部分患者出现尖波。研究组发病后7d和14dEEG轻度异常者均较对照组增加，中、重度EEG异常者均减少[7d轻度（例）：17比7，中度（例）：8比12，重度（例）：5比11；14d轻度（例）：20比11，中度（例）：7比10，重度（例）：3比9，均P〈0．053；脑梗死、脑积水发生率也较对照组明显减少（脑梗死7d：6．7％比26．7％，14d：16．7％比40．0％；脑积水7d：10．0％比33．3％。14d：13．3％比40．0％，均P〈0．05）。结论早期侧脑室穿刺引流能有效改善自发性SAH患者的恢复状况，同时降低SAH造成的脑梗死、脑积水等并发症的发生率。Objective To study the effects of early performing lateral ventricle puncture drainage and intracranial pressure monitoring on complications of patients with spontaneous subarachnoid hemorrhage （SAH） at Hunt-Hess grading Ⅱ- Ⅲ level. Methods A prospective study was conducted. Sixty cases of SAH patients were randomly divided into an experimental group （30 cases）and a control group （30 cases）, and all of the patients underwent cerebral angiography after hospitalization. The positive patients were given intravascular interventional treatment, then lumbar cistern tube drainage was carried out, and other conventional treatment to prevent vasospasm was administered. Based on the routine treatment, the lateral ventricle puncture drainage and intracranial pressure monitoring were performed in the experimental group. And then the sleep-waking cycle of electroencephalogram （EEG）, the incidences of cerebral infarction and hydrocephalus on 7 days and 14 days after the onset were observed. Results The changes of the patients＇ EEG in the two groups were mostly universal cortical changes, manifesting as paroxysmal slow wave of middle and high amplitude. The heavier the grade was, the more frequency the slow wave appeared, and sharp wave maybe occurred in some patients. On 7 days and 14 days after the onset, there were more cases with slight EEG abnormality and less cases with moderate and severe EEG abnormality in the experimental group than those in the control group （7 days slight ： 17 vs. 7, moderate ： 8 vs. 12, severe ： 5 vs. 11 ; 14 days slight ：20 vs. 11, moderate ：7 vs. 10, severe ：3 vs. 9, all P〈0.05）. The incidences of cerebral infarction and hydrocephalus also were less obviously in the experimental group than those in control group （cerebral infarction 7 days ： 6.7% vs. 26.7%, 14 days ： 16.7% vs. 40.0% ; hydrocephalus 7 days ： 10.0% vs. 33.3%, 14 days ： 13.3% vs. 40.0%, all P〈0.05）. Conclusion Early application of lateral ventricle puncture drainage combined with

关 键 词：侧脑室穿刺引流 自发性蛛网膜下腔出血 并发症 

分 类 号：R651.1[医药卫生—外科学] R743.34[医药卫生—临床医学]