脑室外引流联合腰大池引流治疗高分级蛛网膜下腔出血  

External ventricular drainage combined with lumbar drainage in the treament of patients with high-grade aneurysmal subarachnoid hemorrhage

作　　者：夏坤伟 许伟 邵永祥[1] 王均 付宜鑫 周开 张渊 孟桃 XIA Kunwei;XU Wei;SHAO Yongxiang;WANG Jun;FU Yixin;ZHOU Kai;ZHANG Yuan;MENG Tao(The Second People’s Hospital of Yibin,Yibin 644000,China)

机构地区：[1]宜宾市第二人民医院,四川宜宾644000

出　　处：《中国实用神经疾病杂志》2022年第11期1367-1372,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨脑室外引流术(EVD)联合腰大池引流术(LD)对高分级动脉瘤性蛛网膜下腔出血(aSAH)的临床疗效和安全性。方法回顾性分析宜宾市第二人民医院2015-03—2020-11收治的高分级aSAH并早期行手术患者124例,按照治疗方案的不同将患者分为观察组(62例)和对照组(62例),2组均予以开颅动脉瘤栓塞,观察组术后同时安置侧脑室及腰大池引流管,对照组仅安置侧脑室引流管。对比2组术后的近期疗效、神经功能、预后情况、血清免疫球蛋白水平等资料。结果术后2周时,观察组高分级aSAH患者的近期疗效优于对照组,2组差异具有统计学意义(χ^(2)=9.565,P<0.05);术后3个月,2组患者的神经功能评分较术前降低,且观察组评分显著低于对照组(t=2.381,P<0.05);术后观察组出现脑血管痉挛(χ^(2)=4.324,P<0.05)、重度痉挛(χ^(2)=4.133,P<0.05)、脑积水(χ^(2)=10.550,P<0.01)、急性脑积水(χ^(2)=6.459,P<0.01)等事件的概率较对照组显著更低;术后3 d,观察组和对照组的IgA(t=0.452,P=0.652)、IgG(t=1.703,P=0.091)和IgM(t=1.281,P=0.203)组间比较差异无统计学意义(P>0.05)。结论EVD联合LD可以改善高分级aSAH患者的近期疗效和神经功能,患者术后预后效果较好,且对患者免疫功能的影响较小,适合临床推广。Objective To investigate the clinical efficacy and safety of external ventricular drainage(EVD)combined with lumbar drainage(LD)in patients with high-grade aneurysmal subarachnoid hemorrhage(a SAH).Methods A retrospective analysis was conducted and 124 patients with high-grade a SAH from the Second People’s Hospital of Yibin from March 2015 to November 2020 were divided into observation group and control group according to the treatment plan.Both groups were embolized with cranial aneurysm,62 cases in the observation group were treated with EVD and LD after surgery,and 62 cases in the control group were treated with EVD only.The recent efficacy,neurological function,prognosis,and serum immunoglobulin level of the two groups were compared.Results At two weeks postoperatively,the recent outcomes of patients in the observation group were better than that of patients in the control group,with a significant difference between the two groups(χ^(2)=9.565,P<0.05).Three months after surgery,the neurological function scores of patients in both groups were lower than those before surgery,and the scores in the observation group were significantly lower than those in the control group(t=2.381,P<0.05).The probabilities of events such as cerebral vasospasm(χ^(2)=4.324,P<0.05),severe spasm(χ^(2)=4.133,P<0.05),hydrocephalus(χ^(2)=10.550,P<0.01),and acute hydrocephalus(χ^(2)=6.459,P<0.01)were significantly lower in the observation group(P<0.05).At 3 d after surgery,there was no statistically significant comparison between the observation and control groups in terms of Ig A(t=0.452,P=0.652),Ig G(t=1.703,P=0.091)and Ig M(t=1.281,P=0.203).Conclusion EVD combined with LD could improve the recent outcomes and neurological function of patients with high-graded a SAH,providing a better prognosis and less damage in patient immune function,which is suitable for clinical promotion.

关 键 词：动脉瘤 蛛网膜下腔出血 脑室外引流术 腰大池引流术 临床疗效 

分 类 号：R743.35[医药卫生—神经病学与精神病学]