蛛网膜下腔出血后脑脊液引流与脑血管痉挛的关系

目的：研究实验性蛛网膜下腔出血（SAH）后脑脊液中积血量的变化与脑血管痉挛（CVS）的关系。方法：经皮枕大池二次注血法建立犬SAH动物模型,设立早期引流组、晚期引流组和对照组,测定脑脊液中积血量的变化,脑血管造影确定血管痉挛程度（proportion reduction of basilar artery diamiter,%RBAD)。结果：早期引流组脑脊液中积血的清除最明显,晚期引流组其次,脑血管痉挛早期引流组例数最少,程度最轻;晚期引流组其次。结论：SAH后脑脊液中积血越多,持续时间越长,脑血管痉挛发生率越高,程度越高。SAH后腰池持续引流有预防和治疗CVS的作用,早期引流可以取得更好的效果。

Relationship between cerebral vasospasm and drainage of cerebral spinal fluid following subarachnoid hemorrhage

Objective: To investigate the relationship between hematocele change of cerebral spinal fluid (CSF) and cerebral vasospasm(CVS) following experimental subarachnoid hemorrhage(SAH).Methods: An experimental SAH model was achieved in dogs by twice injecting fresh autologous arterial blood into the cisterna magna of each animal.The hematocele change in CSF were measured at different stages in early drainage group,later drainage group and control group respectively.The degrees of CVS were analyzed through cerebral angiography (proportion of reduction of basilar artery diamiter, %RBAD). Results:The early drainage group had a higher clearing rate of hematocele in CSF than other 2 groups following "two injection" model, the later drainage group had a higher clearing rate of hematocele than that of control group only after draining.Compared with other 2 groups,the early drainage group had less CVS and the degrees of CVS were slighter.Conclusion:Large volume of hematocele in CSF in experimental SAH leads to a high incidence of CVS and the degree of CVS become more severe as time goes on.Lumber subarachnoid space continuous drainage following SAH can prevent CVS.Early drainage may lead to a better outcome.