外伤性蛛网膜下腔出血致脑血管痉挛及脑积水防治的研究

目的 :分析研究外伤性蛛网膜下腔出血 (tSAH)腰穿放出血性脑脊液 (CSF)防治脑血管痉挛(CVS)、脑缺血和脑积水。方法 :对急性颅脑损伤经脑CT诊断及腰穿证实的单纯或合并轻度脑挫裂伤的蛛网膜下腔出血患者 (GCS>8分)共 96例随机分为两组 ,经腰穿放出血性CSF的治疗组 48例和常规治疗的对照组 48例 ,对两组治疗效果和愈后进行比较。首先根据脑CT对tSAH的出血量及范围分型 ;再应用经颅多普勒(TCD)观察脑动脉血的流速及指数诊断CVS ,分为轻、中、重度CVS。腰穿治疗组均在伤后 2 4h内行腰穿放血性CSF ,每日 1次 ,每次 50～70ml,直至CSF逐渐清澈为止。随访时间 6个月至 1年。结果 :治疗组只有 6例出现早期轻中度CVS ,仅有 4例额颞叶局限性梗塞灶和 1例轻度脑积水 ,无死亡病例。良好率91 7% ,与对照组有显著差异性(P <0 0 1 )。结论 :腰穿放出血性CSF治疗tSAH致CVS和预防脑积水的方法操作简单、安全可靠、病程短、疗效显著 ,对减轻症状及改善愈后有重要意义 ,易于临床推广

Study on Prevention and Treatment of Cerebral Vasospasm and Hydrocephalus Induced by Traumatic Subarachnoid Hemorrhage

HTSSObjective:To study on the effect of l umbar puncture (Lp)letting out cerebrospinol fluid(CSF) on cerebral vasospasm(CV S),cerebral ischemia and hydrocephalus.Methods:96 patients of acut e craniocerebral injury diagnosed as simple subarachnoid hemorrhage or ones comp licated with mild contrusion were randomly divided into two groups:treatment gr o up(48 cases),with hemorrhagic CSF letted out underwent Lp;control group(48 cases ),with routine treatment.The effect and prognosis of two groups were compared.Ba sed on CT imaging,The volume and scope of traumatic subarachnoid hemorrhage(tSAH ) were typed,then the degree of CVS(mild moderate and severe CVS) were determine d based on arterial velocity and index by transcranial dopple (TCD) methods.Lp w a s performed in 24 hours,50 to 70ml,daily,until liquid recovered as clear as norm al.The Follew up was 6 moths to l year.WTHZResults:WTIn treatment group,ther e were 6 c ases with mild CVS,4 froutal-temporal lobe infarction of brain and 1 hydro ceph alus.The total effective rate was 91.7%.There was significant difference between two groups WTBX(P<0.01)WT.Conclusion:Lp procedure for treat ment with CVS induced by tSAH and prevention of hydrocephalus is simple,safe,eff ective and easy to be spread clinically.