腰椎穿刺脑脊液置换对不同级别蛛网膜下腔出血患者介入栓塞术后的疗效研究  

Effect of cerebrospinal fluid replacement by lumbar puncture for subarachnoid hemorrhage patients of different modified Fisher scale after interventional treatment

作　　者：刘君鹏[1,2] 程琼[1,2] 李云飞[1,2] 汪银洲[1,2] Liu Junpeng;Cheng Qiong;Li Yunfei;Wang Yinzhou(Shengli Clinical College of Fujian Medical University,Fuzhou 350001,China;Department of Neurology,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福州350001 [2]福建省立医院神经内科,福州350001

出　　处：《创伤与急诊电子杂志》2020年第4期157-163,共7页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省科技厅社发处的引导性项目(2017Y0019)。

摘　　要：目的对比研究腰椎穿刺脑脊液置换对不同改良Fisher评分分级的蛛网膜下腔出血(subarachnoid hemorrhage,SAH)介入栓塞术后患者的影响。方法回顾性纳入在福建省立医院行介入栓塞术的125例SAH患者,将患者以轻度出血(改良Fisher评分0~1分)和中重度出血(改良Fisher评分2~4分)两个级别分级后,对这两级患者按照是否行腰椎穿刺脑脊液置换分为常规治疗+脑脊液置换组(A组)及常规治疗组(B组)。分别对比不同级别两组患者的脑血管痉挛、继发性脑梗死、脑积水、死亡率、头痛持续时间、住院时间及术后90d改良Rankin评分(modified Rankin score,mRS)。结果改良Fisher评分2~4分的SAH患者介入栓塞术后,A组的脑血管痉挛、继发性脑梗死、脑积水发生率及术后90d mRS均较B组低,A组头痛持续时间、住院时间较B组短,两组比较差异均有统计学意义(P<0.05)。两组死亡率差异无统计学意义(P>0.05)。改良Fisher评分0~1分的SAH患者介入栓塞术后,A组的脑血管痉挛发生率较B组低、头痛持续时间较B组短(P<0.05),继发性脑梗死、脑积水、死亡率、住院时间、术后90d mRS两组间差异无统计学意义(P>0.05)。多变量Logistic回归分析显示,术前改良Fisher评分2~4分(OR=3.314,95%CI:1.011~10.867;P=0.048)和术前Hunt–Hess评分Ⅲ~Ⅳ级(OR=11.366,95%CI:3.013~41.957;P<0.050)是临床转归不良的独立危险因素。结论SAH介入栓塞术后对改良Fisher评分为2~4分的患者进行腰椎穿刺脑脊液置换,可快速减轻症状,减少并发症的发生,改善预后,安全性良好。Objective To compare the effect of cerebrospinal fluid(CSF)replacement by lumbar puncture for subarachnoid hemorrhage(SAH)patients of different modified Fisher scale after interventional treatment.Methods Data of 125 SAH patients who underwent interventional treatment were reviewed.Based on modified Fisher scale,all the patients were classified to grade 0 to 1 or grade 2 to 4.In each grade,the patients were divided into group of routine medical treatment+CSF replacement(group A)and group of routine medical treatment(group B)according to whether or not CSF replacement by lumbar puncture had been performed.We compared the rate of cerebral vascular spasm,secondary cerebral infarction,hydrocephalus,mortality,duration of headache,duration of hospital stays and modified Rankin scores(mRS)after 90 days between the two groups.Results For patients with grade 2 to 4 SAH who underwent interventional treatment,the rate of cerebral vascular spasm,secondary cerebral infarction,hydrocephalus,duration of headache,duration of hospital stays and mRS after 90 days in the group A were lower than those in the group B(P<0.05).There was no statistically significant difference in the rate of mortality between 2 groups(P>0.05).For patients with grade 0 to 1 SAH,the rate of cerebral vascular spasm and duration of headache in the group A were lower than those in the group B(P<0.05).There was no statistically significant difference in the rate of secondary cerebral infarction,hydrocephalus,duration of hospital stays,mortality and mRS after 90 days between 2 groups(P>0.05).Multifactor unconditional logistic regression indicated that,grade 2 to 4 of modified Fisher scale and grade 3 to 4 of Hunt-Hess scale were independent adverse prognostic factors.Conclusion CSF replacement by lumbar puncture is safe for the SAH patients with grade 2 to 4 of modified Fisher scale who underwent interventional treatment.It may relieve symptoms,reduce complications and improve prognosis.

关 键 词：蛛网膜下腔出血 腰椎穿刺脑脊液置换 介入栓塞术 改良Fisher评分分级 

分 类 号：R743.35[医药卫生—神经病学与精神病学]