|
|
Effect of early external ventricular drainage combined with lumbar cistern drainage after interventional treatment of aneurysmal subarachnoid hemorrhage |
SUN Yan1, NIE Jing1, ZHANG Qiaolian2, CHEN Xuyi3, MA Tiezhu1 |
1. Department of Neurological Critical Care Medicine, 2. Internal Medicine-Neurology, 3. Institute of Medical Safeguards for Maritime Rights Protection, Characteristic Medical Center of Chinese People's Armed Police Force,Tianjin 300162,China |
|
|
Abstract Objective To explore the clinical effect of early external ventricular drainage (EVD) combined with lumbar cistern drainage (LD) after interventional treatment of aneurysmal subarachnoid hemorrhage (aSAH).Methods Eighty patients with aSAH admitted from February 2020 to February 2023 were randomly divided into an experimental group and a control group after vascular intervention treatment. EVD and LD were performed in the test group within 24 hours, and LD was performed in the control group. The patients in both groups were given routine anti vasospasm and symptomatic support treatment. The hemoglobin content in cerebrospinal fluid and the blood flow velocity of the affected side of the middle cerebral artery between the two groups on the 1st, 3rd, and 5th day of drainage were compared. The incidence of complications (cerebral vasospasm, delayed cerebral infarction and Hydrocephalus) and the International Glasgow Outcome Score (GOS) at discharge were also compared.Results On the 3rd and 5th day of drainage, the hemoglobin levels in LD cerebrospinal fluid of patients in the combined treatment group were significantly lower than those in the control group, and the difference was statistically significant (P<0.05). On the third day of drainage, the total amount of cerebrospinal fluid hemoglobin in the drainage fluid of the experimental group was higher than that of the control group, with a statistical difference (P<0.05). On the 5th day of drainage, the average flow velocity of the middle cerebral artery in the experimental group [(101.4±6.2)cm/s]was lower than that in the control group [(118.5±7.5)cm/s], with a statistical difference (P<0.05). The incidence of cerebral vasospasm, delayed cerebral infarction, hydrocephalus and other complications in the test group were lower than those in the control group (P<0.05). The GOS score of the experimental group at discharge [(4.32±0.69) points] was higher than that of the control group [(3.98±0.73) points], with a statistical difference (P<0.05).Conclusions LD combined with EVD can accelerate the clearance of blood in cerebrospinal fluid of patients with aSAH, reduce the incidence of complications such as cerebral vasospasm, delayed cerebral infarction and Hydrocephalus, and improve the overall prognosis of patients.
|
Received: 01 January 2023
|
|
|
|
|
[1] |
Etminan N,Chang H S,Hackenberg K,et al. World-wide incidence of aneurysmal subarachnoid hemorrhage according to region,time period,blood pressure,and s prevalance in the population:a systematic review and meta-analysis [J].JAMA Neurol, 2019,76(5):588-597.
|
[2] |
Chan V,Lindsay P,Mcquiggan J,et al. Declining admission and mortality rates for subarachnoid hemorrhage in Canada between 2004 and 2015 [J].Stroke, 2019,50(1):181-184.
|
[3] |
Kumar G,Shahripour R B,Harrigan M R.Vasospasm on transcranial doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and Meta-analysis[J].J Neurosurg,2016,124( 5 ): 1257-1264.
|
[4] |
吴 鹏, 张德辉, 姚永平. 颅内动脉瘤夹闭术后发生脑血管痉挛的危险因素分析[J]. 解放军医学院学报, 2019, 40(2): 136-139.
|
[5] |
Balanca B,Bouchier B,Ritzenthaler T.The management of delayed cerebral ischemia afteraneurysmal subarachnoid hemorrhage[J].Rev Neurol(Paris),2022,178(1/2): 64-73.
|
[6] |
Bae I S,Tsai M D,Ten D H,et al.Comparison of incidence and risk factors for shunt-dependent hydrocephlus in aneurysmal subarachnoid hemorrhage patients[J].J Cerebrovasc Endovasc Neurosurg,2014,16(2):78-84.
|
[7] |
孙 青, 尤万春, 孙晓欧, 等. 床突旁动脉瘤患者不同治疗方式的效果分析[J].中国脑血管病杂志,2018,15(11):561-566,577.
|
[8] |
Daou B J,Koduri S,Thompson B G,et al.Clinical and experimental aspects of aneurysmal subarachnoid hemorrhage[J].CNS Neurosci Ther,2019,25(10):1096-1112.
|
[9] |
Brami J,Chousterman B,Boulouis G,et al.Delayed cerebral infarction is systematically associated with a cerebral vasospasm of large intracranial arteries[J].Neurosurgery,2020,86(2):E175-E183.
|
[10] |
Osgood M L.Aneurysmal subarachnoid hemorrhage:review of the pathophysiology and management strategies[J].Curr Neurol Neurosci Rep,2021,21(9):50.
|
[11] |
Zinganell A, Bsteh G, Pauli F, et al. Longitudinal ventricular cerebrospinal fluid profile in patients with spontaneous subarachnoid hemorrhage[J]. Front Neurol, 2022, 13: 861625.
|
[12] |
朱雨峰,杨 鹏,金小青,等. 动脉瘤性蛛网膜下腔出血术后持续脑脊液引流作用的Meta分析[J]. 中华神经外科杂志,2021,37(4):406-414.
|
[13] |
Thomas L E, Czuczman A D, Boulanger A B,et al. Low risk for subsequent subarachnoid hemorrhage for emergency department patients with headache, bloody cerebrospinal fluid, and negative findings on cerebrovascular imaging[J]. J Neurosurg, 2014,121(1):24-31.
|
[14] |
雷晓鹏, 张泽平. 可溶性Fms样酪氨酸激酶-1预测急性颅脑损伤蛛网膜下腔出血后脑血管痉挛的研究[J]. 卒中与神经疾病, 2019, 26(4): 427-430.
|
[15] |
谭占国,黄圣明. 蛛网膜下腔出血后迟发脑血管痉挛诊治新进展[J]. 中国临床神经外科杂志, 2019, 24(8): 505-506 .
|
[16] |
Roelz R, Coenen V A, Scheiwe C,et al. Stereotactic catheter ventriculocisternostomy for clearance of subarachnoid hemorrhage: a matched cohort study[J]. Stroke, 2017,48(10):2704-2709.
|
[17] |
Menon G, Menon S, Hegde A. Does universal bypass before carotid artery occlusion obviate the need for balloon test occlusion: personal experience with extracranial-intracranial bypass in 23 patients[J]. J Neurosci Rural Pract, 2019, 10(2): 194-200.
|
[18] |
Wolf S. Rationale for lumbar drains in aneurysmal subarachnoid hemorrhage[J]. Curr Opin Crit Care, 2015,21(2):120-126.
|
[19] |
董 漪,郭珍妮,李 琦,等.中国脑血管病临床管理指南(节选版)—蛛网膜下腔出血临床管理[J].中国卒中杂志,2019,14(8):814-818.
|
[20] |
余 超,屈星怡,许鹏亮,等.去骨瓣减压联合颅内压监测下脑室外引流治疗重症高血压脑出血9例[J].武警医学,2023,34(2):163-165.
|
[21] |
刘 宙,赵学明.成人脑室内出血并发慢性脑积水的研究进展[J].中国微侵袭神经外科杂志,2020,25(1):46-48.
|
[22] |
徐跃峤,石广志,魏俊吉,等.重症动脉瘤性蛛网膜下腔出血管理专家共识(2023)[J].中国脑血管病杂志,2023,20(2):126-145.
|
[23] |
中国医师协会神经介入专业委员会,中国颅内动脉瘤计划研究组.中国颅内破裂动脉瘤诊疗指南2021[J].中国脑血管病杂志,2021,18(8): 546-574.
|
[1] |
. [J]. Med. J. Chin. Peop. Armed Poli. Forc., 2023, 34(2): 163-165. |
|
|
|
|