动脉瘤性蛛网膜下腔出血后急性期脑脊液引流对脑积水形成的影响

目的探讨动脉瘤性蛛网膜下腔出血（SAH）后急性期脑脊液引流对脑积水形成的影响。方法按84例动脉瘤性SAH患者对治疗方案的选择随机分为两组：病因治疗组42例,在急性出血期首先对破裂的动脉瘤进行血管内栓塞,然后立即将蛛网膜下腔的积血引流出;保守治疗组42例采用常规对症治疗。分析两组的临床资料及脑积水形成情况。结果两组患者的基线临床资料比较差异均无显著性（P均〉0.05）,具有可比性。病因治疗组急性期脑积水的发生率为7.14%（3/42例）,亚急性期为4.76%（2/42例）,慢性期为16.67%（7/42例）,总发生率为28.57%;保守治疗组急性期脑积水发生率为23.81%（10/42例）,亚急性期为9.52%（4/42例）,慢性期为35.71%（15/42例）,总发生率为69.05%。两组急性期与慢性期脑积水发生率比较差异有显著性（急性期χ^2=4.46,慢性期χ^2=3.94,P均〈0.05）,两组亚急性期发生率比较差异无显著性（χ2=0.72,P〉0.05）,病因治疗组脑积水总发生率显著低于保守治疗组（χ^2=13.77,P〈0.01）。结论动脉瘤性SAH后在急性出血期（7d内）首先对颅内动脉瘤进行血管内栓塞,然后立即将蛛网膜下腔的积血引流出的治疗方法对减轻或预防脑积水的发生发展具有重要意义。

Effect of drainage of the cerebrospinal fluid at the acute period of aneurysmal subarachnoid hemorrhage on the formation of hydrocephalus

OBJECTIVE: To discuss the effect of drainage of the cerebrospinal fluid (CSF) at acute period after aneurysmal subarachnoid hemorrhage (SAH) on the formation of hydrocephalus. METHODS: Eighty-four patients with aneurysmal SAH were randomly divided into two groups according to therapeutic regimen. Forty-two cases in specific treatment group were given intravascular embolism at the acute period of hemorrhage after a ruptured aneurysm, then CSF was drainaged immediately. Forty-two cases were in conventional expectant treatment group. Clinical data and incidence of hydrocephalus of specific treatment group and conventional expectant treatment group were analyzed. RESULTS: Clinical data did not show any differences between two groups, so they could be compared (all P>0.05). The incidence rate of acute hydrocephalus in specific treatment group was 7.14% (3/42 cases), that of subacute hydrocephalus was 4.76% (2/42 cases), and that of chronic hydrocephalus was 16.67% (7/42 cases). The total incidence rate was 28.57%. In conventional expectant treatment group, the incidence rate of acute hydrocephalus was 23.81% (10/42 cases), incidence of subacute hydrocephalus was 9.52% (4/42 cases), and that of chronic hydrocephalus was 35.71% (15/42 cases), and total incidence rate was 69.05%. There was significant difference between specific treatment group and conventional expectant treatment group in incidence of acute and chronic hydrocephalus (acute chi (2)=4.46, chronic chi (2)=3.94, both P<0.05), and there was no difference in subacute hydrocephalus between two groups (chi (2)=0.72, P>0.05), but significant difference was found in total incidence rate between two groups (chi (2)=13.77, P<0.01). CONCLUSION: Embolization of the intracranial aneurysm with interventional treatment at the acute hemorrhage stage (within 7 days) for the aneurysmal SAH, followed by immediate drainage of CSF can prevent hydrocephalus or alleviate hydrocephalus, and the treatment plays a significant role in the formation and development of hydrocephalus.