动脉瘤性蛛网膜下腔出血患者行腰大池置管引流治疗发生分流依赖性脑积水的相关因素研究

目的探讨动脉瘤性蛛网膜下腔出血患者行腰大池置管引流治疗发生分流依赖性脑积水的相关因素。方法回顾性分析2010年5月至2013年8月间接受治疗的动脉瘤性蛛网膜下腔出血(a SAH)患者42例的临床资料。所有患者Hunt-Hess分类法分级为Ⅰ~Ⅲ级,均行手术治疗;手术治疗过程中或手术后1~3 d对所有患者行腰大池置管引流治疗。观察患者分流依赖性脑积水发生情况,分析脑积水组与非脑积水组患者与Hunt-Hess分级、置管平均天数、急性脑室扩大、动脉瘤的位置和手术方式的关系。结果 42例患者中有7例(16.7%)发生分流依赖性脑积水。1其中入院Hunt-Hess分级Ⅰ级发生分流依赖性脑积水者占6.7%,Ⅱ级占11.1%,Ⅲ级占44.4%。Hunt-Hess高的患者更易发生分流依赖性脑积水。2发生分流依赖性脑积水患者腰大池置管平均天数明显长于未发生脑积水患者(14.7±1.9 d比8.9±1.8 d)。3急性脑室扩大者发生脑积水的患者比率明显高于未出现急性脑室扩大的患者比率(44.4%比9.1%)。4后循环动脉瘤发生分流依赖性脑积水的发生率最高,为33.3%;其次为后交通动脉动脉瘤,占25.0%。5行手术夹闭治疗的患者出现分流依赖性脑积水比率低于行血管内栓塞治疗的患者(14.8%比20.0%),但差异无显著性。结论动脉瘤性蛛网膜下腔出血患者行引流治疗时发生分流依赖性脑积水与Hunt-Hess分级、动脉瘤位置、急性脑室扩大和置管天数有关,而与治疗方法无关。

Study on relevant factors of shunt-dependent hydrocephalus when occurred in aSAH patients given lumbar catheter drainage treat-ment

Objective To study relevant factors of aneurysmal subarachnoid hemorrhage（ aSAH）patients given lumbar catheter drainage treatment when occurring shunt-dependent hydrocephalus. Methods Retrospective analysis May 2010 to August 2013 for treatment of aSAH clinical data of 42 cases. All patients Hunt-Hess grade classification grade Ⅰ - Ⅲ,underwent surgery;surgery during or after surgery,1-3 d for all patients with lumbar catheter drainage treatment. According to shunt-dependent hydrocephalus to analysis Hunt-Hess grade,the aver-age number of days of catheterization,acute ventricular dilatation,aneurysm location and surgical approach were observed. Results Seven cases （16. 7%）occurred shunt dependency hydrocephalus in 42 patients. ①which admission Hunt-Hess grade 1 to gradeⅠcases,Ⅱgrade 2 cases,Ⅲ grade 4 patients,Hunt-Hess more likely in patients with high shunt-dependent hydrocephalus. ②occurrence of cerebral shunt-dependent hydrocephalus patients with lumbar puncture tube was significantly longer than the average number of days hydrocephalus patients（14. 7 ± 1. 9 d ratio of 8. 9 ± 1. 8 d）did not occur. ③proportion of patients with acute ventricular dilatation occurs hydrocephalus does not appear significantly higher in patients with acute ventricular dilatation（44. 4% compared with 9. 1%）. Communicating artery aneurysm and posterior circulation aneu-rysms after. ④shunt-dependent hydrocephalus highest incidence was 33. 3% in posterior circulation aneurysm;followed by 25. 0% in the poste-rior communicating artery aneurysm. ⑤line treatment of patients with surgical clipping of the emergence of shunt-dependent hydrocephalus ratio endovascular embolization patients（14. 8% compared to 20. 0%）below the line,but the difference was not statistically significant. Conclusion Occurs when treatment aneurysmal subarachnoid hemorrhage patients underwent drainage shunt -dependent hydrocephalus and Hunt -Hess grade level,the position of the aneurysm,acute ventricular dilatation catheter or n