两种脑脊液置换术对蛛网膜下腔出血迟发性血管痉挛的防治作用

目的比较持续腰大池引流和腰椎穿刺脑脊液置换术对蛛网膜下腔出血迟发性血管痉挛的防治作用。方法选择蛛网膜下腔出血患者46例,随机分为2组:A组24例,持续腰大池引流,B组22例,腰椎穿刺脑脊液置换术。行经颅多普勒检查比较介入治疗后1、7、14、21、28 d的血管痉挛情况,血管痉挛用大脑中动脉平均流速(MCAVm)及Lingdegaard指数表示,并统计2种脑脊液置换术的不良反应。结果 2组患者血管痉挛程度在介入治疗后1 d无明显差异,A组患者在介入后7、14 d MCAVm及Lingdegaard指数明显低于B组(103.89±29.61)cm/s vs(134.31±30.17)cm/s,(1.701±0.670)vs(1.943±0.711),P<0.05;(99.27±20.11)cm/s vs(111.49±27.45),(1.569±0.487)vs(1.858±0.736),P<0.05],介入治疗后21 d差异不明显(P>0.05)。2组患者不良反应发生率比较,差异无统计学意义。结论介入治疗后14 d内,持续腰大池引流对于改善血管痉挛情况优于腰椎穿刺脑脊液置换,21 d后则不明显。2种方法的不良反应接近。

Effects of two cerebrospinal fluid drainage methods on prevention and treatment of delayed vasospasm after subarachnoid hemorrage

Objective To compare the effects of continuous lumbar cerebrospinal fluid drainage (CLCFD) and lumbar puncture cerebrospinal fluid replacement(LPCFR) on prevention and treatment of delayed vasospasm after subarachnoid hemorrhage(SAH).Methods Forty-six SAH patiants were randomly divided into CLCFD group(group A,n = 24) and LPCFR group(group B, n = 22).The patients underwent transcranial Doppler examination on days 1,7,14,21,28 after intervention therapy.Vasospasm was expressed as the mean velocity of middle cerebral artery (MCAVm) and the Lingdegaard index.Adverse effects of the two replacement methods were recorded. Results No significant difference was found in vasospasm between the two groups on day 1 after intervention therapy.The MCAVm and Lingdegaard index were significantly lower in group A than in group B on days 7 and 14 after intervention therapy(103.89±29.61 cm/s vs 134.31±30.17 cm/s,1.701±0.670 vs 1.943±0.711,P<0.05;99.27±20.11 cm/s vs 111.49 + 27.45 cm/s,1.569±0.487 vs 1.858±0.736,P<0.05).However,no significant difference was observed between the two groups on day 21 after intervention therapy.No significant difference was found in adverse effects of the two replacement methods between the two groups.Conclusion The effect of CLCFD is better than that of LPCFR on delayed vasospasm on day 14 after intervention therapy,but its effect is not noticeable on day 21 after intervention therapy.The adverse efects of the two methods are similar.