目的探讨颅内破裂动脉瘤血管内介入栓塞术后行早期血性脑脊液引流的临床效果。方法本研究对2007年1月—2016年7月江苏大学附属澳洋医院神经外科收治的40例颅内动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage,aSAH）患者在血管内介入栓塞术后早期接受腰椎穿刺引流和脑室持续外引流以引流血性脑脊液的治疗结果进行回顾性分析。结果40例患者中,颅内动脉瘤破裂后2~7 d并发脑血管痉挛12例（30.0%）,经对症治疗后病情缓解;出院后1~2个月,3例（7.5%）患者出现脑积水;术后1个月时,改良Rankin量表分级结果显示,37例（1级）为恢复良好,2例（2级）为轻度残疾,1例（6级）为预后不良（家属放弃治疗后,因肺部感染而死亡）。至随访结束,39例患者中,37例（94.9%）患者治愈或好转;2例（5.1%）患者智力下降,但未发生偏瘫、失语和肢体功能障碍等严重的后遗症。结论颅内动脉瘤破裂出血后早期血管内介入栓塞治疗后行腰椎穿刺引流和脑室持续外引流以释放血性脑脊液,可以显著降低患者的并发症发生率,缩短恢复时间,是一种操作简便、安全而廉价的有效治疗方法。
Abstract
Objective: To evaluate the effectiveness of early hemorrhagic cerebrospinal fluid drainage after interventional embolization for ruptured intracranial aneurysm.Methods: From January 2007 to July 2016, a total of 40 patients with aneurysmal subarachnoid hemorrhage (aSAH) were admitted in Department of Neurosurgery, Aoyang Hospital Affiliated to Jiangsu University, and treated with intervention therapy including lumbar puncture and drainage and/or external ventricular drainage. The treatment outcomes were retrospectively evaluated.Results: Of 40 patients, 12 patients (30.0%) developed cerebral vasospasm during 2-7 days after onset of aneurysm rupture, and were relieved after symptomatic treatment. Three patients (7.5%) developed hydrocephalus 1-2 months after discharge. The modified Rankin scale evaluation showed that 37 patients (grade 1) recovered well, 2 patients (grade 2) had mild disability, and 1 patient (grade 6) had poor outcome (the family abandoned the treatment, and the patient died of lung infection). At the end of follow-up, 37 patients (94.9%) were cured or improved, and the intelligence of 2 patients (5.1%) was decreased, and no patients developed severe sequelaes such as hemiplegia, aphasia and limb dysfunction.Conclusion: Early hemorrhagic cerebrospinal fluid drainage after interventional embolization for ruptured intracranial aneurysm can release the hemorrhagic cerebrospinal fluid to obviously reduce the incidence of complications and shorten the recovery time, so it is a simple, safe, inexpensive and effective treatment therapy.
关键词
动脉瘤 /
破裂 /
蛛网膜下腔出血 /
脑脊液引流 /
介入栓塞
Key words
Aneurysm /
ruptured /
Subarachnoid hemorrhage /
Cerebrospinal fluid drainage /
Interventional embolization
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