| Objective To investigate the lumbar catheter drainage combined with interventional embolization in the treatment of aneurysmal subarachnoid hemorrhage is feasible;and compared with the lumbar puncture cerebrospinal fluid replacement. To evaluate the clinical curative effect of lumbar cistern tube drainage.Methods 76 cases in our hospital were diagnosed by CTA or DSA in 72 hours after interventional aneurysm embolization in patients with aneurysmal subarachnoid hemorrhage, the patients, divided into study group and control group, 35 cases in the control group, 41 cases in the research group. Two groups of patients with interventional embolization in aortic aneurysm were treated with dehydration, reducing intracranial pressure, alleviate vasospasm(Nimotop 10mg/50 m L Bayer 5m L/h infusion pump continuous intravenous infusion therapy(3H), elevated blood pressure, expansion of blood volume, dilution of blood), and prevention of epilepsy, the prevention of upper digestive tract bleeding and other conventional treatment. The control group in the conventional treatment on the basis of daily Department of internal medicine lumbar puncture cerebrospinal fluid replacement, each release of bloody cerebrospinal fluid about 20 ~ 40 m L; in the head CT examination showed subarachnoid hemorrhage disappeared completely or cerebrospinal fluid routine, biochemical test results to normal or near normal after the cessation of operation, a total of 7-14 days. Research groups in the aneurysm embolization satisfied after 8 ~ 12 hours(i.e. after anesthesia) for lumbar cistern drainage drainage bloody cerebrospinal fluid. By adjusting the external auditory canal drainage bottle and relative height to adjust the drainage, drainage volume of about 200 ~ 350 m L; CT examination showed subarachnoid hemorrhage disappeared completely, cerebrospinal fluid routine, biochemical test results to normal or near normal after removal of the drainage device, usually 7 to 14 days. Continuous drainage of cerebrospinal fluid in 14 days if RBC is more than 100×106 /L, in order to prevent infection or stop drainage drainage tube. Monitoring of the two group patients after 1 days, 3 days, 7 days, 10 days, 14 days of middle cerebral artery(MCA) mean blood flow velocity of every other day record; cerebrospinal fluid cerebrospinal fluid pressure; red blood cell count, the incidence of intracranial pressure recovery time and other indicators and adverse reaction.Results The mean blood flow velocity of two groups of patients with MCA was third in the pathogenesis of aneurysmal subarachnoid hemorrhage after the day began to increase, and the incidence of 7d ~ 8d and reached the peak at 10 d, and gradually decline; comparison of mean blood flow velocity of two MCA visible, in the 7d, 10 d, 14 d of group MCA blood flow velocity was significantly lower than that of the control group(P < 0.05); on the fourteenth day, MMCA of the study group MMCA was lower than that of 120cm/s, while the control group was higher than that of 120cm/s. The number of red blood cells, cerebrospinal fluid and cerebrospinal fluid pressure in the third, 7, 9D group index lower than that of the control group, the difference was statistically significant(P < 0.05). The comparison of two groups of patients with intracranial pressure recovery time, the study group than in the control group, the difference was statistically significant(P < 0.05). The adverse reaction rate had no significant difference between two groups(P > 0.05).Conclusion1. In intracranial aneurysms embolization(with dense packing) underwent lumbar cistern drainage can effectively reduce the incidence of postoperative patients with aneurysmal subarachnoid hemorrhage cerebral vasospasm in patients with subarachnoid space; can accelerate the blood clearance rate, promote the restoration of normal cerebrospinal fluid, accelerate the improvement of cerebral vascular spasm,improve the symptoms of headache. Shorten the average hospitalization period of patients, reduce hospitalization expenses.2. Lumbar cistern drainage will not cause repeated trauma, increase the treatment compliance of patients, effective, safe, interventional embolization combined with lumbar cistern tube drainage method can be used as a routine method for treatment of a SAH, and it is worthy of clinical popularization.3. Although the continuous lumbar cistern drainage is at risk of intracranial infection to patients, but the operation process in strict accordance with the matters needing attention, can significantly reduce the adverse reaction of infection. |
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