论文部分内容阅读
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 multiple small volume cerebrospinal fluid replacement in the treatment of acute spontaneous subarachnoid hemorrhage. Methods: A total of 60 patients with acute spontaneous subarachnoid hemorrhage who were seen in the emergency ICU of our hospital from 2010-08-2011-08 were enrolled in this study. All patients underwent hematoma and intraparenchymal hemorrhage by CT and / or MRI and cerebral angiography. Aneurysms, arteriovenous malformations, cavernous hemangiomas, and other patients in need of surgical or interventional treatment were randomly divided into two groups: conventional treatment group (30 cases) and cerebrospinal fluid replacement group (30 cases). The conventional treatment group to take the traditional treatment and only give a simple release of cerebrospinal fluid. The cerebrospinal fluid replacement group was given hemorrhagic cerebrospinal fluid by 7 times lumbar puncture with a small volume of 0.9% saline, and cerebrospinal fluid cytology was performed after operation. Results: After treatment, the clinical symptoms of CSF replacement group were significantly improved compared with the conventional treatment group. The total effective rate of patients in CSF replacement group was significantly higher than that of routine treatment group (P <0.05). The results of cerebrospinal fluid cytometry showed that compared with the conventional treatment group, there were significant differences in the cerebrospinal fluid red blood cell count and white blood cell count before CSF replacement in the CSF replacement group (P <0.05) There was a significant difference between the number of white blood cells and the number of white blood cells (P <0.05). Conclusions: Multiple small volume cerebrospinal fluid replacement can effectively improve cerebrospinal fluid circulation in patients with acute spontaneous subarachnoid hemorrhage and relieve the clinical symptoms such as headache, vomiting and meningeal irritation. This method is simple, small trauma and safe and effective treatment, suitable for primary hospital.