Lumbar Pool Continuous Drainage Effects Were Compared With Drug Treatment Of Subarachnoid Hemorrhage And Cerebrospinal Fluid Replacement Alone Analysis

Obejective: subarachnoid hemorrhage (SAH) is one of the emergencies in neurology department, delayed cerebral vessels spasm (DCVS)is its common complication with high incidence rate about 30%-60%. DCVS is the most important death cause of SAIl patients. It is difficult to cure these patients with only medical treatment. Replacement of the cerebrospinal fluid by lumbar puncture can clean up haematocele in subarachnoid space quickly and decrease the incidence of mutilation and death and now it is widely used to treat SAH patients. But with this method the cerebrospinal fluid being drained is limited and patients are easy to be nervous. Persistent cerebrospinal fluid draining by putting a canal in lunar subarachnoid space, which abide by the physiological mechanisms of cerebrospinal fluid circulation and more cerebrospinal fluid could be replaced, more hematocele could be cleared. Combined treatment with Urokinase(UK) and dexamethasone can dissolve most of the hematocele, lower the intracranial pressure, palliate the blood irritation and decrease the incidence of cerebral vessel spasm. Some research have been done in overseas, we did not find any research about this field in china. In this research we investigate the curative effect of persistent cerebrospinal fluid draining by lumbosubarachnoid cannula combining with UK and dexamethasone intradural injection to SAH patients, compared with the common method of replacing the cerebrospinal fluid by lumbar puncture. We also investigate its preservation effect to DCVS diagnosed by TCD.Method: Divide the SAH patients in our hospital from 2003.6 to 2006.6 into treatment group and control group. All these patients were diagnosed by the SAIl diagnostic criteria established by the chinese cerebrovascular disease metting 1996, and confirmed by computed tomography(CT). Hunt level were scored every patient.All of them were treated with dehydrater, haemostat, and calcium channel blocker. Patients in the control group received lumbar puncture and replacement of the cerebrospinal fluid,as 20ml cerebrospinal fluid was released and equal volume of normal saline was injected. In the first 4days once replacement every day, in the after days once every 2 or 3 days.Patients in the treatment group were dealt with persistent cerebrospinal fluid draining by lumbosubarachnoid cannula combining with Urokinase(UK) and dexamethasone intradural injection. Patients received normal lunar puncture. After measuring the intracranial pressure, a 16 code segmental eqidural catheter was put into the cephalad subarachnoid space. A tubing and an asepsis drainage pack were connected to the end of the catheter, controlling the drainage rate to 150～300ml/24h.In.the following 3 days, 20 thousand units UK was injected intradural and the catheter was clipped for 2h after 24h drainage. 12h after UK was injected, 10mg dexamethasone was injected intradural and the catheter was clipped for 2h again. In both group, when the routine and biochemistry examination of the cerebrospinal fluid was completely normal, the replacement or drainage ended. Record the time when the headache was relieved, the cerebrospinal fluid pressure was normal and the patients woke up,respectively. CT scans was done at 1, 2, 4, 7, 10 and 15 days after the drainage ended to record the time when the haematocele was cleared up. All these patients received TCD every day after the operation, to detect the blood flow rate of all intracranial vassels DCVS was diagnosed if the blood flow rate was beyond 140cm/s and identified by MRA. Compared the incidence of DCVS between these two groups.Result: There were 39 patients in the treatment group and 35 patients in the control group. There were e in sex age and disease composition and the hunt level between these two groups,.There were significant differences in time of headache relief, haematocele disappearing, cerebrospinal fluid pressure becoming normal and patients waking up between these two groups. The incidence of DCVS was significant different between these two groups, too. Conclusion: Treating SAH patients with persistent cerebrospinal fluid draining by lumbosubarachnoid cannula combining with UK and dexamethasone intradural injection is safe and effective, which have a better curative effect and a lower incidence of DCVS.than the common method of replacing the cerebrospinal fluid by lumbar puncture...