PICC管持续腰大池引流联合尼莫地平鞘内注射治疗动脉瘤性蛛网膜下腔出血的临床研究

目的:探索PICC管持续腰大池引流联合尼莫地平鞘内注射治疗动脉瘤性蛛网膜下腔出血的疗效影响。方法:选择动脉瘤性蛛网膜下腔出血患者80例,随机分为观察组和对照组,每组各40例。对照组:发病72 h内行颅内动脉瘤夹闭术或介入栓塞动脉瘤,并予吸氧、镇静、控制血压、降低颅内压、抗纤溶及防治脑血管痉挛(尼莫地平30 mg/d,2~4 ml/h,微量泵静脉泵入)等常规治疗。观察组:发病72 h内行颅内动脉瘤夹闭术或介入栓塞动脉瘤,予吸氧、镇静、控制血压、降低颅内压、抗纤溶等常规治疗的基础上,同时应用PICC管持续腰大池引流联合尼莫地平鞘内注射治疗(尼莫地平30 mg/d)。治疗1个月后,观察两组患者的临床疗效,并比较两组患者Glasgow预后评分及脑血管痉挛发生率。结果:治疗1个月后,观察组患者临床疗效的有效率明显高于对照组,差异有统计学意义(P<0.05);观察组患者Glasgow预后评分明显高于对照组,且脑血管痉挛发生率明显低于对照组,差异均有统计学意义(P<0.05)。结论:PICC管持续腰大池引流联合尼莫地平鞘内注射有效地治疗动脉瘤性蛛网膜下腔出血,值得临床进一步推广。

Clinical research on aneurysmal subarachnoid hemorrhage treated by continuous lumbar drainage using PICC tubes jointed with nimodipine intrathecal injection

Objective To explore the curative effect on aneurysmal subarachnoid hemorrhage treated by continuous lumbar drainage using PICC tubes jointed tion.Method 80 patients were randomly divided into observation group and control group,which had been diagnosed as aneurysmal subarachnoid hemorrhage.Each group contained 40 patients,and were all performed operations using intracranial aneurysm surgery or interventional embolism aneurysms within 72 h.The methods of treatment in the control group were routine treatments,such as using oxygen,sedation,controlling the blood pressure,decreasing intracranial pressure and preventing and treating cerebral vasospasm（ nimodipine,30mg/d,2 ~4 ml/h,micro pump intravenous infusion）.Excepting the nimodipine using micro pump intravenous infusion,the observation group added continuous lumbar drainage using PICC tubes jointed with nimodipine intrathecal injection（ nimodipine,30 mg / d）.After 1 month of treatment,we observed the clinical effects,and compared the Glasgow Outcome Scores and the incidences of cerebral vasospasm in two groups.Results After 1 month of treatment,the effective rates in the observation group were significantly higher compared to the control group（ P〈0.05）.In addition,the Glasgow Outcome Scores in the observation group were higher,and the incidences of cerebral vasospasm were lower in comparison with the control group（ P〈0.05）.Conclusion Continuous lumbar drainage using PICC tubes jointed with nimodipine intrathecal injection has an obviously positive effect on the therapy of aneurysmal subarachnoid hemorrhage,and it is worth of further promotion in the clinical work.