腰穿置管引流术联合高压氧治疗外伤性蛛网膜下腔出血的疗效  

Continuous Lumbar Drainage Combined with Hyperbaric Oxygen Therapy for Traumatic Subarachnoid Hemorrhage

作　　者：熊鹏举[1] 李彬[1] 邓磊[1] 钱锁开 

机构地区：[1]中国人民解放军第九四医院神经外科,南昌330002

出　　处：《南昌大学学报（医学版）》2014年第9期50-52,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的：探讨腰穿置管引流术联合高压氧治疗外伤性蛛网膜下腔出血（tSAH）的疗效。方法将165例tSAH 患者按随机数字表法分为3组：联合治疗组58例，早期（伤后12～24 h）行腰大池持续脑脊液外引流术，并尽早行高压氧治疗；腰穿置管组54例，早期行腰大池持续脑脊液外引流术；高压氧治疗组53例，仅采用高压氧治疗，不行腰椎置管引流脑脊液。所有患者留置引流管＜2周；高压氧治疗每日1次，10 d 为1疗程，共完成2个疗程。对3组患者头痛及意识障碍持续时间、脑积水及继发癫痫的发生情况及预后（恢复良好、轻度残疾、重度残疾、植物生存、死亡）进行比较。结果联合治疗组患者意识障碍、头痛持续时间及并发症（脑积水、继发癫痫）发生例数均显著少于腰穿置管组及高压氧治疗组，预后明显好于腰穿置管组及高压氧治疗组（均 P ＜0．05）。结论腰穿置管引流术联合高压氧治疗 tSAH 能尽快地缓解患者临床症状，有效地降低脑积水、癫痫等严重并发症的发生，显著改善预后，是 tSAH 有效的治疗措施。Objective To investigate the efficacy of continuous lumbar drainage combined with hyperbaric oxygen therapy in the treatment of traumatic subarachnoid hemorrhage（tSAH）.Meth-ods A total of 165 patients with tSAH were randomly treated with continuous lumbar cerebro-spinal fluid drainage 12-24 hours after injury（lumbar drainage group,n=54）,hyperbaric oxygen therapy（hyperbaric oxygen therapy group,n=53）,or their combination（combination group,n=58）.The indwelling drainage tube was placed for 〈2 weeks,and hyperbaric oxygen therapy was performed once daily for 10 days as a course of treatment.After 2 courses of treatment,the dura-tion of headache and conscious disturbance,incidence of hydrocephalus and secondary epilepsy, and prognosis（good recovery,mild disability,severe disability,vegetative survival and death）were compared among the three groups.Results Compared with lumbar drainage group or hyperbaric oxygen therapy group,the duration of headache and conscious disturbance was shortened,the inci-dence of hydrocephalus and secondary epilepsy was decreased and the prognosis was improved in combination group（P 〈0.05）.Conclusion Continuous lumbar drainage combined with hyperbaric oxygen therapy can effectively alleviate clinical symptoms,reduce serious complications and im-prove prognosis in patients with tSAH.

关 键 词：外伤性蛛网膜下腔出血 腰穿置管引流 高压氧 疗效 

分 类 号：R651.15[医药卫生—外科学]