摘要
目的 探究腰大池持续外引流对创伤性蛛网膜下腔出血患者脑CT灌注成像及临床预后的影响。 方法 将解放军第一○五医院神经外科自2012年9月至2014年3月收治的32例创伤性蛛网膜下腔出血患者按随机数字表法分为对照组（进行常规治疗）、治疗组（进行常规治疗＋腰大池持续外引流）,于伤后第3、7、14天行脑CT灌注成像检查以收集相关参数如脑血容量（CBV）、脑血流量（CBF）、对比剂达峰时间（TTP）、对比剂平均通过时间（MTT）,并于治疗后6个月门诊随访,比较2组不同时间点脑CT灌注成像参数及临床预后指标的差异. 结果 伤后第7天治疗组CBV、CBF明显高于对照组,TTP、MTT明显低于对照组,差异有统计学意义（P＜0.05）。2组患者伤后第7天与伤后第3天比较,CBV、CBF均明显降低,TTP明显升高,差异有统计学意义（P＜0.05）。秩和检验发现,治疗组治疗后6个月GOS预后评分与对照组比较差异有统计学意义（P＜0.05）,治疗组疗效明显优于对照组（平均秩次分别为16.63、12.04）。治疗组脑梗死（0例）、脑积水（1例）发生例数低于对照组（1例、2例）。 结论 创伤性蛛网膜下腔出血会导致脑血管痉挛,降低脑血流灌注,而腰大池持续外引流能快速廓清血性脑脊液缓解脑血管痉挛,改善患者的脑血流灌注,减少并发症,从而改善患者预后。
Objective To explore the effect of lumbar continuous drainage on cerebral computed tomography perfusion and clinical outcomes in patients with traumatic subarachnoid hemorrhage （tSAH）.Methods Thirty-two patients with tSAH,admitted to our hospital from September 2012 to March 2014,were divided randomly into 2 groups （n=16）：control group （giving conventional treatment） and treatment group （performing lumbar continuous drainage）.CT cerebral perfusion imaging was performed on the 3rd,7th and 14th day of tSAH; parameters as cerebral blood volume （CBV）,cerebral blood flow （CBF）,time to peak contrast agent （TTP） and mean transit time （MTT） were collected.Clinical follow-up was performed six months after treatment.The differences of cerebral perfusion parameters and clinical outcomes of the two groups were compared and analyzed statistically.Results CBV and CBF were significantly higher and TTP and MTT were significantly lower in the treatment group than those in the control group on the 7th day of tSAH （P〈 0.05）.In the treatment group,the CBV and CBF were significantly decreased and TTP was significantly increased on the 7th d oftSAH as compared with those on the 3rd d of tSAH （P〈0.05）.The GOS scores in the treatment group were significantly higher than those in the control group 6 months after treatment （P〈0.05）.The treatment efficacy in the treatment group was obviously better than that in the control group （average rank：16.63 vs 12.04）.The number ofpatietns appeared cerebral infarction and hydrocephalus in the treatment group （0 and 1） was lower than that of control group （1 and 2）.Conclusions TSAH can result in cerebral vasospasm,and then,reduce the cerebral blood perfusion.Lumbar continuous drainage can relieve cerebral vasospasm,improve cerebral blood perfusion,decrease the complications and improve the outcomes of tSAH patients.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2015年第2期181-184,共4页
Chinese Journal of Neuromedicine
基金
2009年南京军区医学科技创新重点课题（09Z009）
关键词
腰大池持续引流
创伤性蛛网膜下腔出血
CT灌注成像
脑血管痉挛
Lumbar continuous drainage
Traumatic subarachnoid hemorrhage
Computed tomography perfusion
Cerebral vasospasm
