腰大池引流速度对颅内动脉瘤性蛛网膜下腔出血患者炎症相关标记物的影响  

Influence of lumbar cistern drainage velocity on inflammatory markers in patients with aneurysmal subarachnoid hemorrhage

作　　者：王玉莉 胡红旗[1] 郭东才[1] 孙来广[1] 邢振义[1] WANG Yu-li;HU Hong-qi;GUO Dong-cai;SUN Lai-guang;XING Zheng-yi(Department of No.1 Neurosurgery,Xinxiang City Central Hospital,Xinxiang 453000,Henan,China)

机构地区：[1]新乡市中心医院神经外科一

出　　处：《广东医学》2020年第1期77-81,共5页Guangdong Medical Journal

摘　　要：目的分析腰大池脑脊液引流速度对颅内动脉瘤性蛛网膜下腔出血患者血清炎症相关标记物的影响,并探讨对血管内皮功能及大脑血流速度的影响。方法选取90例因颅内动脉瘤破裂引起的蛛网膜下腔出血患者,所有患者均行腰大池置管脑脊液持续引流,按照引流速度不同,随机分为V1(30例)、V2(30例)、V3(30例)3组,引流速度分别控制为5、10、15 mL/h。采用ELISA或放射免疫法检测各组治疗前后血清中炎性因子如白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)及单核细胞趋化蛋白(MCP)-1,血管内皮功能相关指标如内皮素(ET)-1、可溶性细胞间黏附分子(sICAM)-1、血管内皮生长因子(VEGF)及降钙素基因相关肽(CGRP)水平,采用彩色多普勒超声测定大脑动脉的血流速度,并观察3组疗效与不良反应。结果 3组患者治疗前各项炎症因子、血管内皮功能相关指标及大脑动脉血流速度差异均无统计学意义(P>0.05)。治疗后1和3 d,V2组中血清IL-8、TNF-α、CRP及MCP-1水平均低于V1组和V3组(P<0.05);V2组血清ET-1、sICAM-1、VEGF水平均低于V1组及V3组,而血清CGRP水平均高于V1组及V3组(P<0.05)。治疗后1 d,V2组大脑前、中、后动脉血流速度均低于V1组和V3组(P<0.05);治疗后3 d,V2组大脑前动脉血流速度均低于V1组和V3组,与V1组比较差异有统计学意义(P<0.05),V1、V3、V2三组大脑中、后动脉血流速度逐渐降低,V2组与V1组和V3组比较差异有统计学意义(P<0.05)。V2组脑脊液澄清及拔管时间短于V1组(P<0.05),脑脊液澄清时间与V3组比较差异无统计学意义(P>0.05),拔管时间长于V3组(P<0.05)。V2组无不良反应的发生,V1组和V3组均存在不良反应。结论腰大池脑脊液引流速度控制在10 mL/h能减轻炎症反应及血管内皮损伤,并可减慢大脑动脉血流速度,缩短治疗时间,避免不良反应发生。Objective To study the effect of cerebrospinal fluid drainage velocity of lumbar cistern on serum inflammatory markers, vascular endothelial function and cerebral blood flow velocity in patients with intracranial aneurysm subarachnoid hemorrhage(SAH). Methods Ninety patients with SAH caused by ruptured intracranial aneurysm in our hospital were enrolled and treated with continuous drainage of cerebrospinal fluid in lumbar cistern. They were randomly divided into three groups, Group V1(n=30), Group V2(n=30) and Group V3(n=30), in which the drainage speed was set as 5, 10 and 15 mL/h, respectively. The levels of serum inflammatory factors such as IL-8, TNF-α, CRP and MCP-1, and vascular endothelial function related indexes such as ET-1, sICAM-1, VEGF and CGRP of the three groups before and after treatment were measured by ELISA. The blood flow velocity of cerebral artery were measured by color Doppler ultrasound, and the curative effect and adverse reactions of the three groups were observed. Results There were no significant difference in inflammatory factors, vascular endothelial function or cerebral artery blood flow velocity among the three groups before treatment(P>0.05). On the first and third day after treatment, the levels of serum IL-8, TNF-α, CRP and MCP-1 in Group V2 were significantly lower than those in Group V1 and V3(P<0.05). The level of serum ET-1, sICAM-1, VEGF in Group V2 were significantly lower than those in Group V1 and V3, while the level of serum CGRP in Group V2 was significantly higher than those in Group V1 and V3(P<0.05). On the 1st day after treatment, the blood flow velocity of anterior, middle and posterior cerebral arteries in Group V2 were significantly lower than those in Group V1 and V3(P<0.05). On the 3rd day after treatment, the blood flow velocity of anterior cerebral artery in Group V2 was significantly lower than those in Group V1(P<0.05). The blood flow velocity of posterior cerebral artery was significantly lower in Group V2 than Groups V1 and V3(P<0.05). The time of cere

关 键 词：腰大池 引流速度 蛛网膜下腔出血 动脉瘤 炎症 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R602[医药卫生—临床医学]