CAJ | 학술논문

目的：探讨腰穿置管引流术联合高压氧治疗外伤性蛛网膜下腔出血（tSAH）的疗效。方法将165例tSAH 患者按随机数字表法分为3组：联合治疗组58例，早期（伤后12～24 h）行腰大池持续脑脊液外引流术，并尽早行高压氧治疗；腰穿置管组54例，早期行腰大池持续脑脊液外引流术；高压氧治疗组53例，仅采用高压氧治疗，不行腰椎置管引流脑脊液。所有患者留置引流管＜2周；高压氧治疗每日1次，10 d 为1疗程，共完成2个疗程。对3组患者头痛及意识障碍持续时间、脑积水及继发癫痫的发生情况及预后（恢复良好、轻度残疾、重度残疾、植物生存、死亡）进行比较。结果联合治疗组患者意识障碍、头痛持续时间及并发症（脑积水、继发癫痫）发生例数均显著少于腰穿置管组及高压氧治疗组，预后明显好于腰穿置管组及高压氧治疗组（均 P ＜0．05）。结论腰穿置管引流术联合高压氧治疗 tSAH 能尽快地缓解患者临床症状，有效地降低脑积水、癫痫等严重并发症的发生，显著改善预后，是 tSAH 有效的治疗措施。
목적：탐토요천치관인류술연합고압양치료외상성주망막하강출혈（tSAH）적료효。방법장165례tSAH 환자안수궤수자표법분위3조：연합치료조58례，조기（상후12～24 h）행요대지지속뇌척액외인류술，병진조행고압양치료；요천치관조54례，조기행요대지지속뇌척액외인류술；고압양치료조53례，부채용고압양치료，불행요추치관인류뇌척액。소유환자류치인류관＜2주；고압양치료매일1차，10 d 위1료정，공완성2개료정。대3조환자두통급의식장애지속시간、뇌적수급계발전간적발생정황급예후（회복량호、경도잔질、중도잔질、식물생존、사망）진행비교。결과연합치료조환자의식장애、두통지속시간급병발증（뇌적수、계발전간）발생례수균현저소우요천치관조급고압양치료조，예후명현호우요천치관조급고압양치료조（균 P ＜0．05）。결론요천치관인류술연합고압양치료 tSAH 능진쾌지완해환자림상증상，유효지강저뇌적수、전간등엄중병발증적발생，현저개선예후，시 tSAH 유효적치료조시。
Objective To investigate the efficacy of continuous lumbar drainage combined with hyperbaric oxygen therapy in the treatment of traumatic subarachnoid hemorrhage(tSAH).Meth-ods A total of 165 patients with tSAH were randomly treated with continuous lumbar cerebro-spinal fluid drainage 12-24 hours after injury(lumbar drainage group,n=54),hyperbaric oxygen therapy(hyperbaric oxygen therapy group,n=53),or their combination(combination group,n=58).The indwelling drainage tube was placed for <2 weeks,and hyperbaric oxygen therapy was performed once daily for 10 days as a course of treatment.After 2 courses of treatment,the dura-tion of headache and conscious disturbance,incidence of hydrocephalus and secondary epilepsy, and prognosis(good recovery,mild disability,severe disability,vegetative survival and death)were compared among the three groups.Results Compared with lumbar drainage group or hyperbaric oxygen therapy group,the duration of headache and conscious disturbance was shortened,the inci-dence of hydrocephalus and secondary epilepsy was decreased and the prognosis was improved in combination group(P <0.05).Conclusion Continuous lumbar drainage combined with hyperbaric oxygen therapy can effectively alleviate clinical symptoms,reduce serious complications and im-prove prognosis in patients with tSAH.