The Clinical Study Of Early Endovascular Treatment Combined With Continuous Drainage Of Lumbar Cistern In The Treatment Of SaSAH

Objective To investigate the clinical efficacy of the Continuous lumbar cistern drainage combined with intravascular embolization treatment of the severe aneurysmal subarachnoid hemorrhage(Sa SAH),and to evaluate its safety and efficacy.Methods To Selecting sixty Sa SAH patients who met the inclusion criteria in our hospital between January 1,2016 and December 31,2018,and all the patients were randomly divided into four groups.That is the group A(Surgical operation clip aneurysms and postoperative intermittent lumbar puncture),the group B(Surgical operation clip aneurysms and postoperative continuous lumbar cistern drainage),the group C(Interventional embolization in 24 hours and postoperative intermittent lumbar puncture),and the group D(Interventional embolization in 24 hours and postoperative continuous lumbar cistern drainage).To recording preoperative general data of all the patients,including Hunt-Hess grading,aneurysm location,and to recording its Glasgow coma scale(GCS)at two stages before and 14 th day after surgery.After lumbar puncture or lumbar cisterna drainage,their red blood cell(RBC)counts in the cerebrospinal fluid(CSF)at 1st,3rd,5th and 7th day were recorded.And to recording the average hospital stay of all patients.The incidence of complications(CVS,hydrocephalus,Cerebral infarction,and intracranial infection)were recorded.And the Modified Rankin Scale(m RS),the Glasgow Outcome Scale(GOS),the disability rate and the mortality rate were recorded after surgery 3 months.All above data are analyzed statistically.Results 1.The Hunt-Hess grading,gender,age,preoperative GCS score,and RBC count in CSF on the first day after surgery in the four groups were not statistically(P> 0.05).2.Group A VS group C,and Group B VS group D: 1)GCS score on 14 th days after surgery: group C was improved compared with group A,group D was improved compared with group B,and the difference were statistically(P<0.05).2)The RBC count in CSF on the 7th postoperative surgery: group A VS group C,group B VS group D,and there were no significant difference between the groups(P>0.05).3)The average length of stay: group A was higher than group C,group B was higher than group D,and the difference were statistically(P<0.05).4)The complications: group A VS group C,there was no difference between the two groups(P>0.05).The incidence of CVS and hydrocephalus in group D was lower than that in group C,and the difference was statistically(P<0.05).5)GOS score: Group C was better than group A,and Group D was better than group B,and the difference were significant(P < 0.05).6)The m RS score: group C was lower than group A,and group D was lower than group B,and the difference were statistically(P < 0.05).3.Group A VS group B,Group C VS group D: 1)GCS score on 14 th days after surgery: There were no statistical between group A and group B,and between group C and group D(P> 0.05).2)The RBC count: group B was lower than group A,group D was lower than group C,and the difference were statistically(P < 0.05).3)The average length of stay: group A was higher than group B,group C was higher than group D,and the difference were statistically(P<0.05).4)The complications: group A VS group B,there was no difference between the two groups(P>0.05).The incidence of CVS and hydrocephalus and intracranial infection in group D was lower than that in group C,and the difference was statistically(P<0.05).5)GOS score: Group B was better than group A,Group D was better than group C,and the difference were statistically(P < 0.05).6)The m RS score: there was no difference between group A and group B(P> 0.05).Group D was lower than group C,and the difference was statistically(P<0.05).Conclusion For Sa SAH patients,early endovascular treatment is more effective than surgical operation clip aneurysms in improving clinical symptoms,shortening hospital stay and improving prognosis of Sa SAH patients.Compared with the postoperative intermittent lumbar puncture,postoperative continuous lumbar cistern drainage can remove the blood in the subarachnoid space more quickly,reduce the incidence of postoperative complications and improve the prognosis of patients.Early endovascular treatment combined with postoperative continuous lumbar cistern drainage is an effective method for the Sa SAH,which can improve the clinical symptoms of patients,improve the prognosis,shorten the length of stay in hospital,reduce the mortality rate,and reduce the disability rate.