早期连续腰穿对颅内动脉瘤栓塞术后缺血性并发症的影响  

Effects of early continuous lumbar puncture on ischemic complications and related symptoms after intracranial aneurysm embolization

作　　者：任永利 高信京 张英亮 高华 李建国 REN Yongli;GAO Xinjing;ZHANG Yingliang(The Sixth People’s Hospital of Hengshui City,Hebei,Hengshui 053200,China)

机构地区：[1]河北省衡水市第六人民医院神经外科,053200

出　　处：《河北医药》2020年第18期2821-2824,共4页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20170235)。

摘　　要：目的探讨早期连续腰穿在预防颅内动脉瘤栓塞术后患者缺血性并发症及改善其相关症状中的作用。方法以研究单位收治的因颅内动脉瘤性破裂入院的动脉瘤栓塞术治疗患者68例为研究对象,按治疗方法的不同分为对照组和观察组,每组34例。对照组自入院后即给予以全程、足量尼莫地平为主的支持治疗;观察组在对照组治疗的基础上,自栓塞术后24 h内开始连续性腰椎穿刺释放脑脊液,应用经颅多普勒超声(TCD)、美国国立卫生研究院卒中(NIHSS评分)量表和VAS标尺比较2组患者在术后第3、7、10、14、21天时,大脑中动脉(MCA)平均血流速度(MBF)、NIHSS评分及头痛最严重程度等方面的变化,在此基础上结合颅脑CT检查,通过判定无症状性脑缺血(ACI)、症状性脑缺血(SCI)、新发脑梗死(NCI)的发生情况,进而判断2组患者缺血性并发症(IC)的发生率。结果观察组患者在观察时间内较对照组大脑中动脉平均血流速度减缓,NIHSS评分减小,头痛严重程度减弱;缺血性并发症(IC)的总发生率显著降低,差异均有统计学意义(P<0.05)。结论早期连续腰穿可显著降低颅内动脉瘤栓塞术后缺血性并发症的发生率,并能较快缓解其引起的相关症状。Objective To investigate the effects of early continuous lumbar puncture on ischemic complications and related symptoms after intracranial aneurysm embolization.Methods A total of 68 patients with intracranial aneurysm rupture who were admitted and treated by aneurysm embolization in our hospital were enrolled the study,who were divided into control group and observation group according to different treatment methods,with 34 cases in each group.The patients in control group were given supporting therapy with whole range and sufficiency nimodipine on admission,however,the patients in observation group,on the basis of control group,were treated by continuous lumbar puncture to release cerebrospinal fluid within 24h after the operation.The transcranial doppler ultrasonography(TCD),and national institutes of health stroke scale(NIHSS score)and VAS scale were used to observe and compare the average speed of blood flow(MBF)in middle cerebral artery(MCA)at 3d,7d,10,14,21d after operation,and NIHSS score and the changes of the severity of headache between the two groups,on this basis,combining craniocerebral CT examination to determine the incidence of asymptomatic cerebral ischemia(ACI),symptomatic cerebral ischemia(SCI),and new cerebral infarction(NCI),and the incidence of ischemic complications(IC)in the two groups.Results The MBF in middle cerebral artery in observation group was decreased,and the NIHSS scores were decreased,and the severity of headache was relieved,as well as the total incidence rate of ischemic complications(IC)was significantly decreased,and the above differences between the two groups were statistically significant(P<0.05).Conclusion The early continuous lumbar puncture can significantly reduce the incidence rate of ischemic complications after intracranial aneurysm embolization and can alleviate the related symptoms of patients.

关 键 词：早期 连续 腰椎穿刺 动脉瘤栓塞术 缺血性并发症 

分 类 号：R651.12[医药卫生—外科学]