CAJ | 학술논문

目的探讨持续腰椎穿刺引流脑脊液治疗动脉瘤性蛛网膜下腔出血的临床效果.方法选择2006年1月至2013年6月入住解放军第一四八医院、郑州大学第二附属医院神经内科的305例动脉瘤性蛛网膜下腔出血患者,按随机数字表将患者随机分为研究组(152例)和对照组(153例).研究组患者给予标准治疗+腰椎穿刺引流脑脊液,对照组只进行标准治疗.观察2组迟发性缺血性神经功能缺损的发生率和临床改善情况.结果研究组和对照组迟发性缺血性神经功能缺损的发生率分别为21.1％ (32/152)和36.6％ (56/153),组间差异有统计学意义(P=0.018).研究组患者24 h平均引流脑脊液(135±14)ml,平均引流时间(5.2±1.1)d.研究组局灶性缺血者和意识障碍者占比明显低于对照组[8.5％ (13/152)比20.9％(32/153),7.2％(11/152)比9.2％ (14/153)](P=0.015,P=0.036),脑梗死发生率低于对照组[23.3％(35/152)比31.2％ (48/153)] (P=0.036),需要持续脑脊液腹腔分流者占比低于对照组[4.6％(7/152)比7.8％ (12/153)] (P =0.024).在第10天和6个月,研究组改良的Rankin评分0～2分者占比分别为55.3％(84/152)和81.6％(124/152),而对照组分别为34.6％ (53/153)和80.4％(123/153),第10天组间差异有统计学意义(P =0.007).结论动脉瘤性蛛网膜下腔出血后持续腰椎穿刺引流脑脊液能降低迟发性缺血性神经功能缺损的发生率,改善早期临床结果,但对出血后6个月时的临床结果无明显影响.
목적 탐토지속요추천자인류뇌척액치료동맥류성주망막하강출혈적림상효과.방법 선택2006년1월지2013년6월입주해방군제일사팔의원、정주대학제이부속의원신경내과적305례동맥류성주망막하강출혈환자,안수궤수자표장환자수궤분위연구조(152례)화대조조(153례).연구조환자급여표준치료+요추천자인류뇌척액,대조조지진행표준치료.관찰2조지발성결혈성신경공능결손적발생솔화림상개선정황.결과 연구조화대조조지발성결혈성신경공능결손적발생솔분별위21.1％ (32/152)화36.6％ (56/153),조간차이유통계학의의(P=0.018).연구조환자24 h평균인류뇌척액(135±14)ml,평균인류시간(5.2±1.1)d.연구조국조성결혈자화의식장애자점비명현저우대조조[8.5％ (13/152)비20.9％(32/153),7.2％(11/152)비9.2％ (14/153)](P=0.015,P=0.036),뇌경사발생솔저우대조조[23.3％(35/152)비31.2％ (48/153)] (P=0.036),수요지속뇌척액복강분류자점비저우대조조[4.6％(7/152)비7.8％ (12/153)] (P =0.024).재제10천화6개월,연구조개량적Rankin평분0～2분자점비분별위55.3％(84/152)화81.6％(124/152),이대조조분별위34.6％ (53/153)화80.4％(123/153),제10천조간차이유통계학의의(P =0.007).결론 동맥류성주망막하강출혈후지속요추천자인류뇌척액능강저지발성결혈성신경공능결손적발생솔,개선조기림상결과,단대출혈후6개월시적림상결과무명현영향.
Objective To explore the effect of continuous lumbar puncture drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage (aSAH) on delayed ischemic neurological deficit (DIND).Methods From January 2006 to June 2013,305 patients with aSAH were recruited from the 148 Hospital and the Second Affiliated Hospital of Zhengzhou University.According to World Federation of Neurological Surgeons (WFNS) grade 1 to 3 aSAH and modified Fisher grades 2,3,4,patients were randomly divided into the study group and the control group.The study group was given standard therapy plus lumbar drain and the control group was given standard therapy only.The primary observation was the prevalence of DIND and clinical improvement.Results The prevalence of DIND was 21.1％ (32/152) and 36.6％ (56/153) in the study group and in control group; there was significant difference of the incidence of delayed ischemic neurological functional defect between two groups (P =0.018).The average 24 h drainage volume of study group was (135 ± 14)ml and the average drainage time was (5.2 ± 1.1)d.Focal ischemia and the disturbance of consciousness in study group were notably lower than those in the control group[8.5％ (13/152) vs 20.9％ (32/153),7.2％ (11/152) vs 9.2％ (14/153)] (P =0.015,P =0.015) ; the incidence of cerebral infarction was lower than that in the control group [23.3％ (35/152) vs 31.2％ (48/153)] (P =0.036) ; the proportion of patients who needed continuous cerebrospinal fluid peritoneal shunt was lower than that in the control group[4.6％ (7/152) vs 7.8％ (12/153)](P =0.024).At day 10 and 6 month,a modified Rankin Scale score in the study group was 55.3％ (84/152) and 81.6％ (124/152) ; it was 34.6％ (53/153)and 80.4％ (123/153) in the control group.Conclusion Continuous lumbar puncture drainage of cerebrospinal fluid after aSAH can reduce the prevalence of DIND and improve early clinical outcome,but there is no influence at 6 months after aSAH.