摘要
目的:观察多次小容量脑脊液置换术治疗急性自发性蛛网膜下腔出血的可行性及有效性。方法:选取2010-08-2011-08在我院急诊ICU留观的60例急性自发性蛛网膜下腔出血患者,全部经CT和(或)MRI及脑血管造影检查排除血肿、脑实质出血、动脉瘤、动静脉畸形、海绵状血管瘤等需要外科或介入处理的患者,将入选的60例患者随机分成2组:常规治疗组(30例)和脑脊液置换术组(30例)。常规治疗组采取传统治疗方案并仅给予单纯释放脑脊液处理。脑脊液置换术组通过7次腰穿用小容量0.9%生理盐水等量置换出血性脑脊液,术后行脑脊液细胞学检查。结果:脑脊液置换术组经治疗后临床症状较常规治疗组有明显改善。脑脊液置换组患者治疗总有效率与常规治疗组相比较,差异有统计学意义(P<0.05)。脑脊液细胞学检测值结果显示:与常规治疗组相比,脑脊液置换术组第4次置换前脑脊液红细胞数和白细胞数检测值的差异均有统计学意义(P<0.05),第7次脑脊液红细胞数和白细胞数检测值的差异有统计学意义(P<0.05)。结论:多次小容量脑脊液置换术可有效改善急性自发性蛛网膜下腔出血患者脑脊液循环,缓解头痛、呕吐、脑膜刺激征等临床症状。此操作方法简单,治疗创伤小且安全有效,适宜在基层医院开展。
Objective：To observe the feasibility and effectiveness of small volume of cerebrospinal fluid replace- ment in the treatment of acute subarachnoid hemorrhage. Method：Sixty patients with acute spontaneous subarach- noid hemorrhage in our E1CU from August 2010-August 2011 were selected. All patients were confirmed by CT , MRI and cerebral angiography with no hematoma, cerebral hemorrhage,aneurysm,arteriovenous malformations and cavernous hemangiomas et al,which required surgical or interventional treatment,and they were randomly divided into two groups ： the conventional therapy group （30 cases） and cerebrospinal fluid replacement group （30 cases）. Patients in the conventional therapy group were given the traditional treatment and a simple release of cerebrospi- nal fluid. Patients in the cerebrospinal fluid replacement group were given replacement of hemorrhagic CSF through lumbar puncture with equivalent volume of 0.90/6o saline for seven times. The eerebrospinal fluid was sent to make cytology examination. Result：The clinical symptoms of cerebrospinal fluid replacement group improved significantly compared with conventional treatment group after treatment. The difference of the total efficiency between replace- ment group and conventional treatment group was statistically significant （P^0.05）. The difference of the red blood cell number and white blood cell number before the fourth lumbar puncture in CSF replacement group com- pared with the conventional treatment group was statistically significant（P^0. 05） ,the difference was statistically significant （P〈0.05）in the seventh cerebrospinal fluid. Conclusion.. Several times of small capacity fluid replace- ment may be effective in improving the cerebrospinal fluid circulation, relieving headaches,vomiting,meningeal irri- tation and other symptoms. This method is simple,minimally invasive ,safe,effective and appropriate to carry out in the primary hospitals in China.
出处
《临床急诊杂志》
CAS
2013年第1期27-30,共4页
Journal of Clinical Emergency
关键词
蛛网膜下腔出血
脑脊液置换术
subarachnoid hemorrhage
cerebrospinal fluid replacement
