持续腰大池引流在动脉瘤夹闭术后的应用  

Application of continuous lumbar drainage in postoperative aneurysm clip occlusion

作　　者：康睿[1] 陈刚[1] 

机构地区：[1]重庆市合川区人民医院急救中心外二科,401520

出　　处：《重庆医学》2013年第3期281-282,共2页Chongqing medicine

摘　　要：目的探讨持续腰大池引流在动脉瘤夹闭术后的应用价值。方法 285例动脉瘤性蛛网膜下腔出血(CAH)患者在气管插管全麻下先行腰大池置管引流,而后再行动脉瘤夹闭术。在剪开硬脑膜前,打开腰大池引流阀,缓慢释放脑脊液约50mL后关闭。腰大池引流管在术后7d内拔除。结果术前头痛患者231例,引流5d后,头痛明显减轻者219例,占94.8%,术前意识障碍者108例,其中105例意识明显好转,占97.2%,术后7d内出现脑梗死和脑积水的患者分别为33例(11.6%)和6例(2.1%);术后颅内感染51例,全部治愈。恢复良好252例,中残者27例,重残者3例,死亡3例。结论持续腰大池引流能防治脑血管痉挛和脑积水等并发症,缓解患者头痛症状,并发颅内感染时可经腰大池并行鞘内注射药物治疗。Objective To explore the value of continuous lumbar drainage in postoperative aneurysm clip occlusion.Methods 285 cases of aneurismal subarachnoid hemorrhage patients underwent the lumbar drainage in condition of tracheal intubation anesthesia.In the aneurysm clip occlusion,lumbar drainage was opened in front of the opening endocranium.After discharging the cerebrospinal fluid about 50 mL slowly,lumbar drainage was closed and removed within 7 days after operation.Results Headache patients preoperative aneurysm in 231 cases,219 cases were relieved after 5 days of drainage,accounted for 94.8%,Before surgery,108 cases of disturbance of consciousness,and 105 cases of awareness improved markedly,accounted for 97.2%;within 7 days after operation cerebral infarction and hydrocephalus in 33 cases and 6 cases,accounted for 11.6% and 2.1% respectively;postoperative cranial infection in 51 cases were all cured;252 cases were good recovery,27 cases were disabled,3 cases were severe disabled,and 3 cases died.Conclusion Continuous lumbar drainage can prevent cerebral vasospasm and hydrocephalus and other complications,and it can alleviate the symptoms of patients with headache,If patients occurred with intracranial infect at the same time,we should do intrathecal injection by the lumbar.

关 键 词：引流术 颅内动脉瘤 血管外科手术 蛛网膜下腔出血 手术后并发症 

分 类 号：R651.1[医药卫生—外科学]