重症蛛网膜下腔出血动脉瘤手术夹闭后不同引流 方式对疗效的影响
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Effects of different drainage methods after surgical clipping on severe subarachnoid hemorrhage aneurysms
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    摘要:

    目的 研究并比较重症蛛网膜下腔出血患者经动脉瘤手术夹闭后采用腰大池持续引流 术和腰椎穿刺引流术治疗的临床疗效。方法 选取首都医科大学宣武医院2014 年7 月—2017 年6 月收 入的重症蛛网膜下腔出血患者100 例为研究对象,分为两组各50 例,研究组患者手术夹闭动脉瘤后进 行腰大池持续引流术,对照组患者手术夹闭动脉瘤后进行腰椎穿刺引流术,比较两组患者的临床疗效 以及并发症情况。结果 治疗后研究组患者的头痛缓解时间和颅内压降低至正常时间均显著低于对照 组(P< 0.05)。研究组的治疗总有效率(78.00%)显著高于对照组(42.00%)(χ2=13.50,P< 0.05),研究组 脑血管痉挛、脑积水并发症的发生率(14.00%、8.00%)显著低于对照组(42.00%、28.00%)(χ2=9.72、9.07, P< 0.05);两组患者的再出血和脑梗死发生率差异无统计学意义(P> 0.05)。治疗前两组患者GCS 评分 均显著提高(P < 0.05),且研究组的GCS 评分显著高于对照组(P < 0.05)。结论 采用手术夹闭动脉瘤 后辅助腰大池持续引流术对重症蛛网膜下腔出血患者治愈率高,并发症发生率低,可以显著改善患者 的预后。

    Abstract:

    Objective To study and compare the clinical efficacy of lumbar cistern continuous drainage and lumbar puncture drainage for severe subarachnoid hemorrhage after clipping aneurysm. Methods A total of 100 patients with severe subarachnoid hemorrhage from July 2014 to June 2017 in Xuanwu Hospital of Capital Medical University were randomly selected and divided into study group and control group, with 50 cases in each. The patients in the study group underwent continuous lumbar drainage after surgical clipping of aneurysm, while the patients in the control group were treated with lumbar puncture after surgical clipping. The clinical curative effects and complications were compared between the two groups. Results After treatment, the time for headache relief and intracranial pressure reducing to normal of the study group were significantly lower than those of the control group( P<0.05). The total effective rate of the study group( 78.00%) was significantly higher than that of the control group( 42.00%)( χ2=13.50, P< 0.05). The incidence of cerebral vasospasm and hydrocephalus complication was 14.00% and 8.00% respectively, which was significantly lower than that of the control group( 42.00%,28.00%)(χ2=9.72, 9.07;P< 0.05). There was no significant difference between the two groups in the incidence of rehemorrhage and cerebral infarction( P>0.05). The scores of GCS of both groups before treatment was significantly lower than those after the treatment( P<0.05). The GCS of the study group after treatment was significantly higher than that of control group( P < 0.05). Conclusions The continuous lumbar drainage after surgical clipping of aneurysm with high curative rate and low incidence of complications, which can significantly improve the patient's prognosis.

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程玮涛.重症蛛网膜下腔出血动脉瘤手术夹闭后不同引流 方式对疗效的影响[J].神经疾病与精神卫生,2018,18(7):
DOI :10.3969/j. issn.1009-6574.2018.07.006.

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  • 在线发布日期: 2018-10-29