术后持续腰大池引流治疗重型颅脑损伤合并蛛网膜下腔出血的研究

发布时间：2018-02-27 20:17

本文关键词： 持续腰大池引流（LCFD）重型颅脑损伤外伤性蛛网膜下腔出血（tSAH）　出处：《苏州大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨术后持续腰大池引流对重型颅脑损伤合并蛛网膜下腔出血（tSAH）的治疗效果。方法：选取我院自2011年10月至2013年5月收治的重型颅脑损伤合并tSAH的患者60例，于开颅术后随机分为两组，实验组30例，行持续腰大池引流术引流脑脊液；对照组30例，行多次腰椎穿刺术放脑脊液；从GCS评分、脑脊液红细胞计数检测、蛛网膜下腔积血清除时间、并发症（脑积水、脑梗塞）的发生率及疗效预后各方面对两组治疗方法进行评价。结果：两组患者治疗5、10d后GCS评分较治疗前显著提高，且治疗后5、10d时实验组GCS评分显著高于对照组（P＜0.05或P＜0.01)；实验组脑脊液中红细胞＜100×106/L的时间较对照组明显提前（P＜0.01)；通过术后复查头颅CT观察蛛网膜下腔出血消散情况，实验组明显优于对照组（P＜0.05）；实验组术后脑积水发生率明显低于对照组（P＜0.05）；出院时按GOS评定预后，，实验组也明显优于对照组（P＜0.05）。结论：重型颅脑损伤合并蛛网膜下腔出血术后早期行腰大池持续外引流能清除血性脑脊液，减少并发症，改善预后，持续腰大池引流在掌握其适应征的前提下是一种比较安全和有效的治疗方法。
[Abstract]:Objective: to investigate the effect of continuous lumbar cistern drainage on severe craniocerebral injury with subarachnoid hemorrhage. Methods: from October 2011 to May 2013, 60 patients with severe craniocerebral injury complicated with tSAH were randomly divided into two groups: the experimental group (n = 30) and the control group (n = 30). The treatment methods of the two groups were evaluated from the aspects of GCS score, cerebrospinal fluid red blood cell count, subarachnoid hemorrhage clearance time, complications (hydrocephalus, cerebral infarction) and prognosis. Results: the GCS score of the two groups was significantly higher than that before treatment for 5 ~ 10 days. The GCS score in the experimental group was significantly higher than that in the control group (P < 0. 05 or P < 0. 01), the time of erythrocyte < 100 脳 10 6 / L in cerebrospinal fluid in the experimental group was significantly earlier than that in the control group (P < 0. 01). The incidence of hydrocephalus in the experimental group was significantly lower than that in the control group (P < 0.05), and the prognosis was assessed according to GOS at discharge, and the experimental group was also significantly better than the control group (P < 0.05). Conclusion: continuous external drainage of lumbar cistern after severe craniocerebral injury combined with subarachnoid hemorrhage can clear cerebrospinal fluid, reduce complications and improve prognosis. Continuous lumbar cistern drainage is a safe and effective treatment under the condition of mastering its adaptive sign.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15

【参考文献】