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目的探讨研究密闭式双腔管腰池循环引流置换脑脊液(CSF)治疗重度蛛网膜下腔出血(SAH)的临床效果。方法共入选重度SAH患者59例,根据入院先后随机分为治疗组(采用双腔管腰池置管密闭式循环引流与置换CSF技术治疗)27例和对照组(采用间断腰穿CSF置换术治疗)32例。观察指标为神经功能缺损评分(NIHSS)、日常生活活动能力评分(ADL)、意识障碍评分(GCS)、头痛缓解时间、蛛网膜下腔血液廓清时间、颅内压及并发症。结果治疗后治疗组NIHSS(7.34±5.15)分、ADL(91.39±15.32)分、GCS(13.98±1.04)分;对照组NIHSS(16.91±7.26)分、ADL(53.86±13.39)分、GCS(10.05±1.46)分。两组比较差异明显(P<0.01);治疗后治疗组并发脑积水脑血管痉挛发生率为29.6%(8/27),低于对照组的59.4%(19/32),差异明显(P<0.05);治疗后治疗组患者头痛缓解时间(5±2.6)d、蛛网膜下腔血液廓清时间(4±1.7)d,低于对照组的(13±1.7)d、(11±2.6)d;治疗后颅内压降低幅度治疗组(85±10 mmH2O)明显大于对照组(35±10 mmH2O)(P<0.01)。结论双腔管腰池置管密闭式循环引流置换CSF技术治疗重度SAH简便易行、安全有效,可降低脑血管痉挛和脑积水的发生率,明显改善预后。
Objective To investigate the clinical effect of closed double-lumen tube lumbar drainage drainage replacement cerebrospinal fluid (CSF) in the treatment of severe subarachnoid hemorrhage (SAH). Methods A total of 59 patients with selected severe SAH were enrolled in this study. Twenty-seven patients were randomly divided into treatment group (treated with double-lumen tube lumbar drainage tube and closed-loop drainage and CSF replacement therapy) and control group (treated by intermittent lumbar puncture and CSF replacement therapy) 32 cases. The observation indexes were NIHSS, ADL, GCS, headache relief time, subarachnoid blood clearance time, intracranial pressure and complications. Results After treatment, NIHSS (7.34 ± 5.15), ADL (91.39 ± 15.32), GCS (13.98 ± 1.04), NIHSS (16.91 ± 7.26), ADL (53.86 ± 13.39), GCS ± 1.46) points. The difference between the two groups was significant (P <0.01). After treatment, the incidence of cerebral vasospasm in the treatment group was 29.6% (8/27), which was lower than that in the control group (59.4%, 19/32) (P (P <0.05). After treatment, headache relief time (5 ± 2.6) d and subarachnoid blood clearance time (4 ± 1.7) d in the treatment group were significantly lower than those in the control group (13 ± 1.7) and (11 ± 2.6) d. After treatment, the treatment group (85 ± 10 mmH2O) in the treatment group with decreased intracranial pressure was significantly larger than the control group (35 ± 10 mmH2O) (P <0.01). Conclusions The double-lumen tube lumbar canal placement of closed drainage and replacement CSF in the treatment of severe SAH is simple, safe and effective, and can reduce the incidence of cerebral vasospasm and hydrocephalus and significantly improve the prognosis.