腰大池引流时程与颅内动脉瘤术后慢性分流依赖性脑积水的关系  

The relationship between the duration of lumbar drainage and shunt-dependent chronic hydrocephalus in ASAH patients after aneurysm clipping

作　　者：郭文才[1] 吴过[1] 熊建平[1] 李锐[1] 

机构地区：[1]巴中市中心医院神经外科,四川巴中636600

出　　处：《现代肿瘤医学》2015年第12期1662-1665,共4页Journal of Modern Oncology

基　　金：四川省科技厅科技支撑项目(编号:2012SZ0127)

摘　　要：目的:探讨腰大池引流时程与颅内动脉瘤术后慢性分流依赖性脑积水之间的相关性。方法:选取我院2010年3月至2012年3月神经外科收治的ASAH患者109例。所有患者在入院时均由医师记录年龄、性别、有无脑室积血、有无急性脑积水、Hunt-Hess分级、蛛网膜下腔出血的改良Fisher分级等资料。采用腰大池引流治疗期间,连续记录患者每日的引流量、脑脊液的形状及其检验结果。结果:年龄(P=0.027)、脑室内积血(P=0.000)、Hunt-Hess分级(P=0.002)、改良Fisher分级(P=0.001)、腰大池引流时程(P=0.017)与慢性分流依赖性脑积水发生情况之间存在关联性。经进一步的Logistic回归分析显示腰大池引流时程、改良Fisher分级是慢性分流性脑积水最主要的危险因素。结论:腰大池引流时程、改良Fisher分级是慢性分流性脑积水最主要的危险因素。但如何选择最佳的腰大池引流时程,减少患者颅内动脉瘤术后慢性分流依赖性脑积水的发生仍需要更多的研究进行探讨。Objective： To investigate the relationship between the duration of lumbar drainage and shunt - depend- ent chronic hydrocephalus in ASAH patients after aneurysm clipping. Methods：All 109 ASAI4 patients in our hospital from 2010 to 2012 were selected. Age, gender,presence of intraventricular hemorrhage, with or without acute hydro- cephalus, Hunt - Hess grade, Fisher grade improvement subarachnoid hemorrhage and other information were recorded when patients admitted to hosipital. With lumbar cistern drainage during the treatment, the shape and the test results of cerebrospinal fluid were record everyday. Results ：Age （ P = 0.027 ） ,intraventrieular hemorrhage（P =0.000 ） , Hunt -Hess grade（ P =0. 002） ,modified Fisher grade（ P = 0. 001 ）, the duration of lumbar cistern drainage（ P = 0. 017 ） were correlated with the presence of chronic conditions and the occurrence of shunt - dependent hydrocephalus. The duration of lumbar cistern drainage,improved Fisher grade, Hunt - Hess grade were risk factors to the chronic hydro- cephalus shunt. Conclusion： Duration of lumbar CSF drainage, initial Hunt - Hess grade, initial Modified Fisher Scale are independent risk factors of SDCH in ASAH patients who were treated with clipping surgery. It is essential to find a valid interyening method and an appropriate duration of lumbar CSF drainage to prevent SDCH at the same time.

关 键 词：颅内动脉瘤 慢性分流依赖性脑积水 腰大池引流时程 危险因素 

分 类 号：R739.41[医药卫生—肿瘤]