腰池引流对破裂动脉瘤患者血浆和脑脊液ET浓度及脑血管痉挛的影响

目的探讨腰池持续引流对破裂动脉瘤患者血浆和脑脊液内皮素(ET)浓度及脑血管痉挛的影响。方法将经栓塞治疗后的破裂颅内动脉瘤患者354例分为引流组和对照组。引流组268例,栓塞后行腰池持续引流;对照组86例,每天腰穿放脑脊液一次。用放免法测定栓塞后不同时间血浆和脑脊液中ET浓度,用经颅彩色多普勒超声检测大脑中动脉血流速度。结果引流组血浆和脑脊液中ET浓度轻度增加,对照组ET浓度增加明显,两组差异显著(P<0.01)。引流组大脑中动脉平均血流流速轻度增加,对照组明显增加,两组差异显著(P<0.01)。血浆和脑脊液中ET浓度与脑动脉血流速度呈正相关(r=0.95,P<0.01)。结论蛛网膜下腔出血后脑血管痉挛与血浆和脑脊液中ET浓度异常增加有关,腰池持续引流能够有效地清除引起脑血管痉挛的因子。

Effect of Lumbar Cistern Drainage on Plasma and CSF Endothelin Concentrations and Cerebral Vasospasm in Patients with Ruptured Aneurysm

Objective To investigate the effects of lumbar cistern drainage on endothelin(ET) concentrations in plasma and cerebral spinal fluid(CSF) and cerebral vasospasm in the patients with ruptured aneurysm. Methods Three hundred and fifty-four patients with ruptured aneurysms, which were embolized by coils, were divided into drainage (268 cases) and control (86 cases) groups. The lumbar cistern drainage was carried out in the drainage group and the CSF was discharged through a lumber puncture per day in the control group. The concentrations of ET in plasma and CSF were determined by radioimmunoassay and the mean velocity of blood flow of the middle cerebral artery (VMCA) was determined by transcranial color Doppler ultrasound at different time after the embolization. Results The plasma and CSF ET concentrations in the drainage group were significantly lower than those in the control group (P<0.01) after the embolization. The VMCA in the drainage group was significantly slower than that in the control group (P<0.01) after the embolization. The positive correlation (r=0.95, P<0.01) was observed between ET and VMCA. Conclusions The cerebral vasospasm after the subarachnoid hemorrhage is positively related to the ET concentrations of plasma and CSF. The factors causing cerebral vasospasm can be removed by lumbar cistern drainage in the patients with ruptured aneurysm.