颅内压监护下脑室外引流联合腰椎穿刺治疗颅脑损伤合并外伤性蛛网膜下腔出血的效果研究  

Efficacy of external cerebral ventricular drainage combined with lumbar puncture under intracranial pressure monitoring in the treatment of craniocerebral truma complicated by traumatic subarachnoid hemorrhage

作　　者：杨培中[1] 刘永博[1] 刘向东[1] Yang Peizhong;Liu Yongbo;Liu Xiangdong(Department of Neurosurgery,Linyi Hospital of Traditional Chinese Medicine,Linyi 276000,China)

机构地区：[1]临沂市中医医院神经外科,临沂276000

出　　处：《中国实用医刊》2025年第1期50-53,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨颅内压(ICP)监护下脑室外引流(EVD)联合腰椎穿刺(以下简称腰穿)治疗颅脑损伤合并外伤性蛛网膜下腔出血(tSAH)的疗效。方法回顾性抽取2022年3月至2024年3月在临沂市中医医院住院治疗的颅脑损伤合并tSAH患者94例,按入院顺序分为常规组和研究组,每组47例。常规组予以甘露醇降颅压等常规治疗,研究组在ICP监测下行EVD联合腰穿治疗。比较两组临床相关指标、蛛网膜下腔淤血消失情况、格拉斯哥昏迷评分量表(GCS)评分和并发症发生情况。结果研究组甘露醇用量少于常规组,脑脊液压力恢复用时和脑脊液转为清亮用时均短于常规组(P均<0.05)。治疗后3 d,研究组蛛网膜下腔淤血消失19例(40.43%,19/47),多于常规组的10例(21.27%,10/47),P<0.05;治疗后7 d,研究组淤血消失45例(95.74%,45/47),多于常规组的37例(78.72%,37/47),P<0.05。治疗后5、10 d,两组GCS评分均高于治疗前,且研究组高于常规组(P<0.05)。研究组并发症发生率(8.52%,4/47)低于常规组(25.53%,12/47),P<0.05。结论ICP监护下行EVD联合腰穿治疗颅脑损伤合并tSAH的效果优于常规治疗,其能减少甘露醇用量,缩短脑脊液压力恢复时间,加速蛛网膜下腔淤血消失,提高GCS评分,并降低并发症发生率。ObjectiveTo investigate the effect of external cerebral ventricular drainage(EVD)combined with lumbar puncture under intracranial pressure(ICP)monitoring in the treatment of craniocerebral trauma complicated by traumatic subarachnoid hemorrhage(tSAH).MethodsA total of 94 patients with craniocerebral trauma complicated with tSAH who were hospitalized in Linyi Hospital of Traditional Chinese Medicine from March 2022 to March 2024 were retrospectively selected,and they were divided into the routine group and the study group according to the order of admission,with 47 cases in each group.The conventional group was treated with mannitol to reduce intracranial pressure and other conventional treatment,and the study group was treated by EVD combined with lumbar puncture under ICP monitoring.The clinical related indexes,disappearance of subarachnoid congestion,Glasgow Coma Scale(GCS)score and complications were compared between the two groups.ResultsThe dosage of mannitol in the study group was less than that in the routine group,and the recovery time of cerebrospinal fluid pressure and the time for cerebrospinal fluid to become clear were shorter than those in the routine group(P<0.05).Three days after treatment subarachnoid congestion disappeared in 19 cases(40.43%,19/47)in the study group,which was higher than the 10 cases(21.27%,10/47)in the routine group(P<0.05).At 7 days after treatment,45 cases(95.74%,19/47)of congestion disappeared in the study group,which was higher than the 37 cases(78.72%,37/47)in the routine group(P<0.05).At 5 and 10 days after treatment,the GCS scores of the two groups were higher than those before treatment,and the GCS scores of the study group were higher than those of the routine group(P<0.05).The incidence of complications in the study group(8.52%,4/47)was lower than that in the routine group(25.53%,12/47),P<0.05.ConclusionsThe curative effect of EVD combined with lumbar puncture under ICP monitoring in the treatment of craniocerebral trauma complicated by tSAH is better than that of con

关 键 词：蛛网膜下腔出血 颅脑损伤 脑室外引流 颅内压 腰椎穿刺 

分 类 号：R651.1[医药卫生—外科学]