Hunt-Hess Ⅰ～Ⅲ级动脉瘤性蛛网膜下腔出血早期手术术前腰大池外引流的临床观察

目的 探讨Hunt-Hess Ⅰ～Ⅲ级动脉瘤性蛛网膜下腔出血(SAH)早期手术术前腰大池外引流的临床疗效.方法 将早期手术的Hunt-Hess Ⅰ～Ⅲ级动脉瘤性SAH患者分为术前腰大池外引流组(47例)和术后腰大池外引流组(54例),分析两组病例的疗效差异.结果 术前腰大池外引流组无置管导致的动脉瘤再破裂出血病例,其术中动脉瘤破裂、症状性脑血管痉挛、慢性脑积水的发生率分别为8.5%、12.8%、12.8%,均低于术后腰大池外引流组的11.1%、20.4%、14.8%.结论 术前行腰大池外引流无增加Hunt-Hess Ⅰ～Ⅲ级动脉瘤性SAH早期手术患者动脉瘤再破裂出血的风险,并且可降低症状性脑血管痉挛和慢性脑积水的发生率.

Abstract：

Objective To explore the therapeutic effect of preoperative external hunbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage ( SAH ) undergoing early surgery for intracranial aneurysms. Method The 101 cases of grade Ⅰ～Ⅲ patients according to the classification of Hunt and Hess with early surgical treatment were devided into preoperative external lumbar drainage group(47 cases) and postoperative external lumbar drainage group(54 cases).Outcome of patients with different external drainage of cerebrospinal fluid was analyzed. Results There was no case of aneurysm rebleeding could be associated with preoperative spinal drain placement. Tne incidences of intraoperative aneurysm rapture in preoperative external lumbar drainage group was 8. 5%,which was lower than 11. 1% in postoperative external lumbar drainage group. The incidences of symptomatic cerebral vasospasm and chronic hydrocephalus in preoperative external lumbar drainage group were 12. 8% and 12.8% ,which were lower than 20. 4% and 14. 8% in postoperative external lumbar drainage group. There all were not significant differences between the two groups. Conclusions Preoperative external lumbar drainage wont increase a risk of rebleeding for grade Ⅰ～Ⅲ patients with aneurysmal SAH undergoing early surg ery. Furthermore, it can decrease the incidences of symptomatic cerebral vasospasm and chronic hydrocephalus,which is a safe and useful method of removing bloody cerebrospinal fluid.