亚低温联合脑室穿刺引流对老年性高分级动脉瘤性蛛网膜下腔出血患者脑血管状态的影响  

Effect of mild hypothermia combined with ventricular puncture and drainage on cerebrovascular status in elderly patients with severe aneurysmal subarachnoid hemorrhage

作　　者：张钰 张湘斌 黄晓松[1] 潘晓彦[3] Zhang Yu;Zhang Xiangbin;Huang Xiaosong;Pan Xiaoyan(Department of Neurology,Hunan Brain Hospital(the Second People's Hospital of Hunan Province),Changsha 410021,China;Department of Neurology,Xiangya Hospital,Central South University,Changsha 410008,China;College of Nursing,Hunan University of Chinese Medicine,Changsha 410218,China)

机构地区：[1]湖南省脑科医院(湖南省第二人民医院)神经内科,长沙410021 [2]中南大学湘雅医院神经内科,长沙410008 [3]湖南中医药大学护理学院,长沙410218

出　　处：《中华脑血管病杂志（电子版）》2023年第3期214-220,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：2016年度湖南省卫生计生委科研计划课题项目(C2016019);湖南省自然科学青年基金项目(2019JJ50313)。

摘　　要：目的分析亚低温联合脑室穿刺引流对老年性高分级动脉瘤性蛛网膜下腔出血患者脑血管状态的影响。方法选取2019年4月至2020年5月在湖南省脑科医院(湖南省第二人民医院)就诊的老年性高分级动脉瘤性蛛网膜下腔出血患者162例,根据随机数字分配法分为脑室穿刺引流治疗组和联合治疗组,各81例。脑室穿刺引流治疗组给予脑室穿刺引流治疗,联合治疗组在脑室穿刺引流治疗组的治疗基础上增加亚低温治疗方法。分别于治疗前、术后7 d、术后14 d采用彩色经颅多普勒血流分析仪对动脉血流速度、颅内压进行检测,采用酶联免疫法检测血浆内皮素、降钙素水平,应用脑室内出血Graeb评分评估脑室内出血状况,应用格拉斯哥预后评分(GOS)评估预后情况。采用独立样本t检验比较上述资料组间差异,采用重复测量方差分析比较治疗前后的差异;采用χ^(2)检验比较组间临床疗效的差异。结果脑室穿刺引流治疗组患者术后7 d、14 d的动脉血流速度[(110.57±11.46)mIU/ml、(80.48±6.35)mIU/ml]、颅内压[(83.91±12.96)mmH_(2)O、(67.47±7.28)mmH_(2)O]、内皮素水平[(25.87±6.58)pg/ml、(15.85±1.59)pg/ml]、Graeb评分[(6.21±0.26)分、(4.12±0.24)分]低于治疗前[(170.25±23.55)mIU/ml、(118.64±14.86)mmH_(2)O、(30.27±6.24)pg/ml、(8.24±0.13)分];降钙素水平[(54.63±5.23)pg/ml、(64.64±5.23)pg/ml]、GOS[(3.56±0.53)分、(5.67±0.56)分]高于治疗前[(34.94±3.53)pg/ml、(1.27±0.87)分],差异具有统计学意义(F=20.510、15.850、4.367、62.850、28.080、20.230,P均<0.001)。联合治疗组患者术后7 d、14 d的动脉血流速度[(98.73±15.20)mIU/ml、(68.74±9.21)mIU/ml]、颅内压[(74.53±13.07)mmH_(2)O、(60.28±6.57)mmH_(2)O]、内皮素水平[(20.47±8.73)pg/ml、(12.48±1.74)pg/ml]、Graeb评分[(6.02±0.24)分、(4.03±0.21)分]低于治疗前[(170.31±18.57)mIU/ml、(118.57±14.93)mmH_(2)O、(30.31±4.86)pg/ml、(8.26±0.57)分],降钙素水平[(59.56�Objective Analyze the effect of mild hypothermia combined with ventricular puncture and drainage on cerebral vascular status in elderly patients with severe aneurysmal subarachnoid hemorrhage.Methods 162 elderly patients with high-grade aneurysmal subarachnoid hemorrhage who visited Hunan Provincial Brain Hospital(the Second People's Hospital of Hunan Province)from April 2019 to May 2020 were selected.according to the random number allocation method is divided into ventricular puncture drainage and treatment group and combined treatment group,each 81 cases,cerebral ventricular puncture drainage treatment group,combined treatment group in the ventricular puncture drainage treatment group on the basis of subhypothermia treatment method.At pre-treatment,7 days and 14 days after surgery,the arterial blood flow velocity and intracranial pressure level were measured by color transcranial Doppler flow analyzer.The plasma endothelin and calcitonin levels were measured by enzyme-linked immunization method.The intraventricular hemorrhage Graeb score was used to evaluate the prognosis of intraventricular hemorrhage and Glasgow outcome score(GOS).The above experimental data were described,independent sample t-test,comparison data before and after treatment for repeated measurement analysis of variance,F-value test;count data were expressed by frequency and percentage,andχ^(2)test for comparison between groups.Results Arterial blood flow velocity[(110.57±11.46)mIU/ml,(80.48±6.35)mIU/ml],intracranial pressure[(83.91±12.96)mmH_(2)O,(67.47±7.28)mmH_(2)O],endothelin[(25.87±6.58)pg/ml,(15.85±1.59)pg/ml],Graeb score[6.21±0.26,4.12±0.24]of ventricular puncture drainage and treatment group 7 days,14 days after surgery were lower than pre-treatment[(170.25±23.55)mIU/ml,(118.64±14.86)mmH_(2)O,(30.27±6.24)pg/ml,8.24±0.13];Calcitonin[(54.63±5.23)pg/ml,(64.64±5.23)pg/ml],the GOS prognostic score level[3.56±0.53,5.67±0.56]was higher than pre-treatment[(34.94±3.53)pg/ml,1.27±0.87],and the difference was statistically sign

关 键 词：亚低温 脑室穿刺引流 蛛网膜下腔出血 老年 脑血管 

分 类 号：R743.35[医药卫生—神经病学与精神病学]