CAJ | 학술논문

目的研究早期侧脑室穿刺引流和颅内压监护对 Hunt-Hess 分级Ⅱ~Ⅲ级自发性蛛网膜下腔出血(SAH)患者并发症的影响.方法采用前瞻性研究方法,将60例自发性 SAH 患者按随机原则分为研究组和对照组两组,每组30例.所有患者入院后均行全脑血管造影检查,阳性者给予血管内介入治疗,术后均给予腰大池置管引流、止血及预防血管痉挛等常规治疗.研究组在常规治疗基础上行侧脑室穿刺引流术及颅内压监护.发病后7 d 及14 d 分别观察患者脑电图(EEC)情况以及脑梗死和脑积水的发生率.结果两组患者 EEC以皮质普遍性改变为主,表现为阵发性中至高幅慢波,分级越重,出现慢波的频率越多,部分患者出现尖波.研究组发病后7 d 和14 d EEG 轻度异常者均较对照组增加,中、重度 EEG 异常者均减少〔7 d 轻度(例):17比7,中度(例):8比12,重度(例):5比11;14 d 轻度(例):20比11,中度(例):7比 10,重度(例):3比9,均P<0.05〕;脑梗死、脑积水发生率也较对照组明显减少(脑梗死7 d :6.7%比26.7%,14 d :16.7%比40.0%;脑积水7 d:10.0%比33.3%,14 d:13.3%比40.0%,均 P<0.05).结论早期侧脑室穿刺引流能有效改善自发性 SAH患者的恢复状况,同时降低 SAH 造成的脑梗死、脑积水等并发症的发生率.
목적연구조기측뇌실천자인류화로내압감호대 Hunt-Hess 분급Ⅱ~Ⅲ급자발성주망막하강출혈(SAH)환자병발증적영향.방법채용전첨성연구방법,장60례자발성 SAH 환자안수궤원칙분위연구조화대조조량조,매조30례.소유환자입원후균행전뇌혈관조영검사,양성자급여혈관내개입치료,술후균급여요대지치관인류、지혈급예방혈관경련등상규치료.연구조재상규치료기출상행측뇌실천자인류술급로내압감호.발병후7 d 급14 d 분별관찰환자뇌전도(EEC)정황이급뇌경사화뇌적수적발생솔.결과량조환자 EEC이피질보편성개변위주,표현위진발성중지고폭만파,분급월중,출현만파적빈솔월다,부분환자출현첨파.연구조발병후7 d 화14 d EEG 경도이상자균교대조조증가,중、중도 EEG 이상자균감소〔7 d 경도(례):17비7,중도(례):8비12,중도(례):5비11;14 d 경도(례):20비11,중도(례):7비 10,중도(례):3비9,균P<0.05〕;뇌경사、뇌적수발생솔야교대조조명현감소(뇌경사7 d :6.7%비26.7%,14 d :16.7%비40.0%;뇌적수7 d:10.0%비33.3%,14 d:13.3%비40.0%,균 P<0.05).결론조기측뇌실천자인류능유효개선자발성 SAH환자적회복상황,동시강저 SAH 조성적뇌경사、뇌적수등병발증적발생솔.
Objective To study the effects of early performing lateral ventricle puncture drainage and intracranial pressure monitoring on complications of patients with spontaneous subarachnoid hemorrhage(SAH) at Hunt-Hess grading Ⅱ-Ⅲ level. Methods A prospective study was conducted. Sixty cases of SAH patients were randomly divided into an experimental group(30 cases)and a control group(30 cases),and all of the patients underwent cerebral angiography after hospitalization. The positive patients were given intravascular interventional treatment,then lumbar cistern tube drainage was carried out,and other conventional treatment to prevent vasospasm was administered. Based on the routine treatment,the lateral ventricle puncture drainage and intracranial pressure monitoring were performed in the experimental group. And then the sleep-waking cycle of electroencephalogram (EEG),the incidences of cerebral infarction and hydrocephalus on 7 days and 14 days after the onset were observed. Results The changes of the patients' EEG in the two groups were mostly universal cortical changes, manifesting as paroxysmal slow wave of middle and high amplitude. The heavier the grade was,the more frequency the slow wave appeared,and sharp wave maybe occurred in some patients. On 7 days and 14 days after the onset, there were more cases with slight EEG abnormality and less cases with moderate and severe EEG abnormality in the experimental group than those in the control group(7 days slight :17 vs. 7,moderate :8 vs. 12,severe :5 vs. 11 ;14 days slight :20 vs. 11,moderate :7 vs. 10,severe :3 vs. 9,all P<0.05). The incidences of cerebral infarction and hydrocephalus also were less obviously in the experimental group than those in control group(cerebral infarction 7 days :6.7% vs. 26.7%,14 days :16.7% vs. 40.0% ;hydrocephalus 7 days :10.0% vs. 33.3%,14 days :13.3%vs. 40.0%,all P<0.05). Conclusion Early application of lateral ventricle puncture drainage combined with intracranial pressure monitoring for patients with SAH can effectively improve their recovery situation,and in the mean time it can decrease the incidences of complications such as cerebral infarction and hydrocephalus,etc.