早期持续腰大池置管引流术治疗动脉瘤性蛛网膜下腔出血后脑血管痉挛的效果  

Effect of early continuous lumbar cistern drainage on cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：宋启星 朱飚[1] 刘保国[1] 郑建桥 张心佟 张龙[1] 田硕[1] SONG Qixing;ZHU Biao;LIU Baoguo;ZHENG Jianqiao;ZHANG Xintong;ZHANG Long;TIAN Shuo(Ward 1,Department of Neurosurgery,Yuebei People's Hospital,Guangdong Province,Shaoguan512000,China)

机构地区：[1]广东省粤北人民医院神经外科一区,广东韶关512000

出　　处：《中国当代医药》2022年第34期135-139,共5页China Modern Medicine

基　　金：广东省韶关市卫生健康科研项目(Y21150)。

摘　　要：目的探讨早期持续腰大池置管引流术治疗动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛(CVS)的效果。方法选取2020年1月至2022年1月粤北人民医院收治的82例aSAH合并CVS患者作为研究对象,按照抽签法将其分为对照组和观察组,每组各41例。对照组患者行腰椎穿刺术引出血性脑脊液,观察组患者行腰大池置管持续引流术。比较两组患者的脑血管痉挛程度、脑血流动力学指标[脑血容量(CBV)、脑血流量(CBF)、对比剂达峰时间(TTP)和对比剂平均通过时间(MTT)]、血清生化指标[基质金属蛋白酶(MMP-9)、S-100钙结合蛋白B(S-100B)]及并发症发生情况。结果观察组患者术后7、14 d的脑血管痉挛程度低于对照组,差异有统计学意义(P<0.05)。观察组患者术后7、14 d的CBV、CBF高于对照组,TTP、MTT低于对照组,差异有统计学意义(P<0.05)。观察组患者术后7、14 d的MMP-9、S-100B水平低于对照组,差异有统计学意义(P<0.05)。观察组患者的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论早期持续腰大池置管引流术治疗aSAH后CVS的效果显著,可有效改善脑组织灌注,降低神经功能损伤,减少并发症风险。Objective To explore the effect of early continuous lumbar cistern drainage on cerebral vasospasm(CVS)after aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 82 patients with aSAH and CVS admitted to Yuebei People's Hospital from January 2020 to January 2022 were selected as research objects and divided into control group and observation group according to drawing lot method,with 41 cases in each group.The control group received lumbar puncture to extract hemorrhagic cerebrospinal fluid,and the observation group received continuous drainage of lumbar cisternal catheter.The degree of cerebrovascular spasm,cerebral hemodynamic indexes(cerebral blood volume[CBV],cerebral blood flow[CBF],peak time of contrast agent[TTP]and mean passage time of contrast agent[MTT]),serum biochemical indexes(matrix metalloproteinase[MMP-9],S-100 calcium-binding protein B[S-100B])and the incidence of complications were compared between the two groups.Results The degree of cerebral vasospasm in the observation group was lower than that in the control group at 7 and 14 days after surgery,and the difference was statistically significant(P<0.05).The CBV and CBF of the observation group were higher than those of the control group at 7 and 14 days after surgery,while the TTP and MTT of the observation group were lower than those of the control group,the differences were statistically significant(P<0.05).The levels of MMP-9 and S-100B in observation group were lower than those in control group at 7 and 14 days after surgery,and the differences were statistically significant(P<0.05).The total incidence of complications in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).Conclusion Early continuous lumbar cistern drainage is effective in the treatment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage.It can effectively improve brain perfusion,reduce neurological damage and reduce the risk of complications.

关 键 词：持续腰大池置管引流 动脉瘤性蛛网膜下腔出血 脑血管痉挛 并发症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]