高分级动脉瘤性蛛网膜下腔出血颅内动脉瘤夹闭术后不同引流方式的疗效及对预后的影响  

Effects of different drainage methods on the prognosis of patients with intracranial aneurysms after aneurysmal subarachnoid hemorrhage

作　　者：刘炎[1,2] 杭春华[2] 茅磊[2] 纪祥军[2] 李桃[2] 

机构地区：[1]南方医科大学研究生学院,210008 [2]南京军区南京总医院神经外科

出　　处：《疑难病杂志》2017年第6期623-626,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨高分级动脉瘤性蛛网膜下腔出血患者颅内动脉瘤夹闭术后不同引流方式的临床疗效,并观察其对患者预后的影响。方法回顾性分析2013年1月—2016年1月南京军区南京总医院神经外科收治的84例高分级动脉瘤性蛛网膜下腔出血患者临床诊治资料,2组患者均于发病3 d内行颅内动脉瘤夹闭术,并进行常规治疗,其中42例术后行常规腰椎穿刺术引流作为对照组,42例行腰大池持续引流术作为观察组。比较2组临床疗效和颅内压恢复正常的时间及头痛缓解时间,记录2组治疗期间并发症,采用格拉斯哥预后评分(G0S)评分评价其预后情况,检测2组治疗前、后大脑中动脉流速(Vm)。结果观察组临床治疗总有效率为76.19%,明显高于对照组的40.48%(χ~2=11.02,P<0.01);观察组颅内压恢复正常的时间及头痛缓解时间分别为(12.62±2.24)d、(11.74±2.17)d,均明显短于对照组的的(16.85±2.46)d、(14.88±2.68)d(t=8.23、5.90,P均<0.01)。观察组脑积水及脑血管痉挛并发症发生率均明显低于对照组(P<0.05);治疗后,2组患者G0S评分及Vm均较治疗前明显下降,观察组各项指标下降程度较对照组更显著(P<0.05)。结论采用腰大池持续引流术可较好地改善高分级动脉瘤性蛛网膜下腔出血患者颅内动脉瘤夹闭术后临床症状,有效缓解其疼痛,并改善其预后,同时并发症少。Objective To explore the clinical efficacy of surgical treatment of patients with subarachnoid hemorrhage high grade aneurysmal and observe its effect on prognosis.Methods A retrospective analysis from January 2013 to January 2016 in Department of Neurosurgery, Nanjing General Hospital of Nanjing Military treated 84 cases of high grade clinical data of patients with aneurysmal subarachnoid hemorrhage, 2 group of patients were at onset within 3d intracranial aneurysm surgery, and received routine treatment, 42 cases underwent routine lumbar puncture drainage as control group, lumbar cistern drainage as the observation group.Time and headache were compared between the 2 groups, clinical efficacy and intracranial pressure recovered the remission time, complications recorded during treatment in the 2 groups, using the Glasgow Outcome Scale （GOS） to evaluate the prognosis score in 2 groups, before and after treatment of middle cerebral artery flow velocity （Vm） were detected.Results The total effective rate of the treatment group was 76.19%, which was significantly higher than that of the control group （40.48%,χ2=11.02,P〈0.01）.The recovery time of the intracranial pressure and headache in the treatment group were （12.62±2.24） d, （11.74±2.17） d, which were significantly shorter than those in the control group （16.85±2.46） d and （14.88±2.68） d, respectively （t=8.23,t=5.90,P〈0.01）.After treatment, GOS score and Vm of the two groups were significantly lower than those of the control group （P〈0.05）.Conclusion The continuous lumbar drainage can effectively improve the clinical symptoms after clipping of intracranial aneurysms in patients with high-grade aneurysmal subarachnoid hemorrhage, effectively relieve the pain and improve the prognosis, and fewer complications, so it is worth further study and discussion.

关 键 词：蛛网膜下腔出血 高分级动脉瘤 颅内动脉瘤夹闭术 腰大池持续引流 腰椎穿刺术引流 

分 类 号：R651.1[医药卫生—外科学]