颅内动脉瘤介入治疗术后腰池引流和间断腰穿防治脑血管痉挛的临床疗效比较

【目的】比较颅内动脉瘤（AN）介入治疗后腰池引流和间断腰穿防治脑血管痉挛（CVS）的疗效。【方法】对40例Hunt—Hess分级相同的AN破裂出血病例按血管内治疗术后行持续蛛网膜下腔引流和间断腰穿释放脑脊液（CSF）分A、B两组，比较两组不同时间点相关指标。【结果】A组大脑中动脉流速（VMCA）明显低于B组且下降速度较快。A组CSF中RBC数目各时段均值明显低于B组，A组下降速率快于B组（均P〈0．05）；两组CSF中内皮素－1（ET－1）浓度在术后d3无显著性差异，其余各时间点均有显著性（P〈0．05），A组的下降速率明显高于B组；术后14d神经功能缺损程度评分及评分减少程度的比较有显著性（P〈0．05）。【结论】AN破裂介入治疗术后持续腰池引流疗效优于间断腰椎穿刺，是防治CVS的首选方式。

Comparison of Clinical Efficacy Between Lumbar Drainage and Intermittent Lumbar Puncture for the Prevention and Treatment of Cerebral Vasospasm after Intervention Treatment of Intracranial Aneurysm

Objective]To compare the efficacy between lumbar drainage and intermittent lumbar puncture for the prevention and treatment of cerebral vasospasm（CVS） after interventional treatment of intracranial aneurysm（AN）. Methods] Forty cases of ruptured hemorrhage after AN with the same Hunt-Hess grade were divided into continuous subarachnoid space drainage group（group A） and intermittent lumbar puncture for the release of cerebrospinal fluid（CSF） group（group B）. The related indexes at different time points were com- pared between two groups. Results]The current velocity of middle cerebral artery（VMCA） in group A was significantly lower and decreased more rapidly than that in group B, and the mean RBC count in CSF of group A at different time points was lower and decreased more rapidly than that of group B（all P 〈0.05）. There was no significant difference in the concentration of endothelin-l（ET-1） in CSF at 3 days after operation between two groups, while that at other time points had significant difference（ P 〈0. 05）. There were significant differences in the score of neurologic impairment and the degree of the decreasing of the score between two groups at 14 days after operation（ P〈0.05）. Conclusion] Continuous lumbar drainage after interventional therapy of ruptured hemorrhage of AN is more effective than intermittent lumbar drainage, so it is the preferred way to preventing and treating CVS.