The Effect And Curative Effect Of Lumbar Drainage Combined With Hyperbaric Oxygen In The Prevention Of Chronic Hydrocephalus After ASAH Operation

Objective: To investigate the effect and therapeutic effect of lumbar drainage combined with hyperbaric oxygen on postoperative prevention of chronic hydrocephalus in Hunt-hess ?,grade aSAH patients.?Method: In this study,we enrolled 145 consecutive patients with Hunt-hess ?,?aSAH admitted to Department of Neurosurgery,Affiliated Hospital of North Sichuan Medical College from September 2015 to July 2017 in a single center,randomized,double-blind and parallel group control study Data,including 48 males and 97 females,all patients with definite aneurysm by DSA,craniotomy aneurysm clipping or endovascular embolization.The specific methods of this study are as follows:(1)The patients who meet the inclusion criteria were randomly divided into three groups.The gender,age,preoperative Hunt-Hess grade and Fisher grade,whether there was hypertension,bleeding into the ventricle or not,general information No statistically significant difference.(2)The three groups were randomly divided into combined group,lumbar group and conventional group,with 47,47 and 51 cases in each group.The combined group was treated with HBO combined with CLD and conventional drug treatment group.The lumbar pool group was lumbar drainage and conventional drug treatment group;the conventional group was conventional drug treatment group.The mean cerebral blood flow velocity(VMCA)was measured by transcranial Doppler ultrasound(TCD)at different time points after operation.Cerebrospinal fluid(CSF)was extracted from the three groups at different time points after operation.Cerebrospinal fluid routine and biochemical tests were performed.The concentration of transforming growth factor-?1(TGF-?1)in cerebrospinal fluid was detected by enzyme linked immunosorbent assay(ELISA).(3)The postoperative GOS scores,the incidence of cerebral vasospasm,the incidence of intracranial infection and the incidence of chronic hydrocephalus in the three groups were calculated.The concentration of TGF-?1 in cerebrospinal fluid was determined by chi-square test and repeated Analysis of variance analysis for significant analysis,draw conclusions.Result:(1)The degree of cerebral vasospasm in the combined group,the lumbar group,and the conventional group decreased in turn,indicating that hyperbaric oxygen and drainage of the waist can relieve cerebral vasospasm to a certain extent.(2)The long-term incidence of chronic hydrocephalus in the combined group was lower than that in the conventional group,while in the lumbar group was lower than that in the conventional group.There was no significant difference between the combined group and the lumbar group,indicating that drainage of the lumbar canal could reduce the occurrence of chronic hydrocephalus Rate,hyperbaric oxygen can not prevent the occurrence of chronic hydrocephalus.(3)There was no significant difference in intracranial infection rate between the three groups.(4)The prognosis of patients(GOS score),waist drainage can improve the long-term prognosis of patients,can not significantly reduce the patient's mortality,and hyperbaric oxygen on the prognosis of patients with no significant effect.(5)The influence of TGF-?1 concentration in cerebrospinal fluidThe expression of TGF-?1 in descending aSAH postoperatively decreased by drainage of the waist-capillaries,but hyperbaric oxygen did not promote the descent of TGF-?1 significantly.Conclusion: aSAH laparoscopic drainage can accelerate the early drainage of subarachnoid hemorrhage,significantly relieve cerebral vasospasm,effectively reducing the concentration of TGF-?1 induced fibrosis,improve the pia mater fibrosis and reduce the The incidence of chronic hydrocephalus,improve the prognosis of patients and improve the quality of life of patients,a reasonable retention of the lumbar does not increase the incidence of intracranial infection.Postoperative early hyperbaric oxygen can relieve cerebral vasospasm,but can not reduce the concentration of TGF-?1 and the incidence of chronic hydrocephalus,can not significantly improve the prognosis of patients and improve the quality of life.Large sample studies and long-term clinical follow-up are also needed.