【摘要】 目的探讨采用早期腰大池持续外引流治疗外伤性蛛网膜下腔出血的疗效。方法伤后24h内行腰大池持续外引流术共73例,选择L3￣4或L4￣5椎间隙行穿刺置管术,使用全封闭无菌腰大池外引流套管(美国产Meditronic),进入椎管内头端方向置入引流管5￣6cm,通过调节引流管及引流袋的位置高低,控制引流量和流速,留管时间3￣10d,平均5￣6d,引流量:200￣300mL/24h。结果本组73例,脑脊液明显转清亮5￣6d,最长10d。拔管时脑脊液细胞计数≤500×106/L,脑膜刺激征消失时间3￣10d(平均6.5d),头痛消失或明显好转3￣14d(平均8.5d),脑脊液压力恢复正常3￣7d(平均4.8d)。5例行腰穿2次成功置管,2例术后48h出现发热、颈强直、脑脊液化验证实颅内感染,经鞘内注入敏感抗生素后,7￣10d后脑脊液恢复正常。症状性脑血管痉挛发生比率9.59%,随访一年后硬膜下积液和脑积水比率4.1%。结论外伤性蛛网膜下腔出血的患者早期腰大池外引流治疗,脑脊液转清快、脑膜刺激征恢复时间短、头痛症状缓解快,随访一年后硬膜下积液和脑积水发生率低,避免了常规腰穿引流量有限,且反复操作导致感染局部红肿等缺陷。更多还原

【Abstract】 Objective To investigate the effect of treating traumatic subarachnoid hemorrhage by lumbar cistern continuous drainage in earlier period. Methods Seventy-three cases were treated by lumbar cistern continuous drainage within 24 h after trauma through intervertebral space of L3~4 or L4~5. The drainage tube (American Meditronic) was all blocked and the drainage tube was inserted into the vertebral canal by 8~10 cm. The flow rate (200~300 mL/24 h) could be controlled through regulating the position of drainage tube and drainage pack. The drainage tube was kept for 3~10 d, average 5~6 d. Results The time of cerebrospinal fluid (CSF) returning to be clear was 5~6 d and the longest was 10 d. The number of CSF cells was less than 500×106/L when extubating. The meningismus disappeared for 3~10 d (average 6.5 d), and the headache disappeared or improved obviously for 3~14 d (average 8.5 d). The pressure of CSF retuned to be normal for about 3~7 d (average 4.8 d). Five cases were lumbar-punctured successfully for 2 times, of which 2 cases had post-operative intracranial infection with fever and neck rigidity and recovered 7~10 d after using sensitive antibiotics. The rate of cerebral angio-spasm was 9.59%. The rate of subdural collection of fluid and hydrocephaly was 4.1% after 1 year. Conclusion The way of lumbar cistern continuous drainage in earlier period is efficient in treating the patients of traumatic subarachnoid hemorrhage. CSF can return soon to be clear. The recovery time of meningismus and headache was short. The rate of subdural collection of fluid and hydrocephaly was low. It can also avoid some shortcomings of normal lumbar puncture such as limited fluence and infection and local swelling due to repeated operations.更多还原