腰大池引流治疗46例外伤性蛛网膜下腔出血临床分析

目的探讨腰大池引流在外伤性蛛网膜下腔出血（tSAH）患者中的应用效果。方法选择2010年6月～2012年10月湖北省老河口市第一医院收治的tSAH患者92例，分为观察组与对照组，每组各46例。观察组给予腰大池引流治疗．对照组给予常规腰穿抽液术治疗，比较两组患者昏迷程度评分（GCS）、过氧化物歧化酶（SOD）、丙二醛（MDA）、头痛视觉模拟评分（VAS）及脑脊液红细胞含量，观察比较两组脑积水发生率及死亡率。结果两组患者治疗5、10d后GCS均较治疗前显著提高，且治疗后5、10d时观察组GCS评分（11．8±2．2）、（14．6±1．7）分1均显著高于对照组（9．1＋2．1）、（12．4＋1．6）分1，差异均有统计学意义（P〈0．05或P〈0．01）；治疗后两组SOD较治疗前均明显增高，且治疗后观察组（91．1±14．8）nU／mL]显著高于对照组（84．4±14．7）nU／mL]，差异均有高度统计学意义（均P〈0．01）；两组MDA、VAS及脑脊液红细胞含量治疗后显著低于治疗前，且治疗后观察组（3．2±1．1）μmol／L、（3．6±1．2）分、（14．3±11．5）×10^8／L]显著低于对照组（3．9±1．1）μmol／L、（35．8±1．3）分、（23．4±11．4）×10^8／L]，差异均有高度统计学意义（均P〈0．01）；观察组治疗后14d时死亡率为6．5％（3／46），显著少于对照组19．6％（9／46）]，差异有统计学意义（P〈0．05）；观察组治疗后3个月脑积水发生率为8．7％（4／46），显著低于对照组的28.3％（13／46），差异有统计学意义（P〈0．05）。结论腰大池引流在外伤性蛛网膜下腔出血患者中疗效确切，安全可靠，值得推广。

The clinical analysis of lumbar drainage of cerebrospinal fluid in 46 patients with traumatic subarachnoid hemorrhage

Objective To study the effects of lumbar drainage of cerebrospinal fluid in patients with traumatic subarachnoid hemorrhage （tSAH）. Methods 92 patients with tSAH from June 2010 to October 2012 in the First Hospital of Laohekou City were selected and randomly divided into observation group （n = 46） and control group （n = 46）. Patients in observation group were treated with lumbar drainage of cerebrospinal fluid, and patients in control group were treated with routine lumbar puncture drainage surgery, then the GCS scores, SOD, MDA, VAS scores of headache and content of red blood cell in cerebrospinal fluid were contrasted between the two groups; hydrocephalus incidence and mortality between the two groups were observed and compared. Results GCS scores in the two groups 5,10 days after the treatment were all better than those before the treatment, GCS scores in observation group 5,10 days after the treatment （11.8±2.2）, （14.6±1.7）] were all better than those in control group （9.1±2.1）, （12.4±.6）], the difference were all statistically significant （P 〈 0.05 or P 〈 0.01）. SOD in the two groups after the treatment were all better than those before the treatment, SOD in the observation group after the treatment （91.1±4.8） nU/mL] was higher than that in control group （84.4±4.7） nU/mL], the difference was statistically significant （P 〈 0.01）; MDA, VAS scores and content of red blood cell in cerebrospinal fluid in the two groups after the treatment were all lower than those before the treatment, the indexes in the observation group after the treatment （3.2±1.1） μmol/L, （3.6±1.2）, （14.3±11.5）×10/L] were all lower than those in control group （3.9±1.1） μmol/L（35.8±.3）, （23.4±11.4）×10^8/L]. The mortality rate of observation group 14 days after the treatment 6.5% （3/46）] was lower than that of control group 19.6% （9/46）], the difference was all statistically significant （P 〈 0.05）; the incidence rate of hydrocephalus in observation group 3 months after the treatment 8.7% （4/46）] was lower than that of control group 28.3% （13/46）], the differenee was all statistically significant （P 〈 0.05）. Conclusion Lumbar drainage of cerebrospinal fluid has exaetly clinical effects in patients with tSAH, it is safe and reliable, worthy of promotion.