动脉瘤性蛛网膜下腔出血后脑脊液引流时间与引流量对脑积水的影响

Effects of duration and volume of cerebrospinal fluid drainage on occurrence of hydrocephalus after aneurysmal subarachnoid hemorrhage

摘要:

目的 讨论脑脊液腰大池引流时间长短及引流量对动脉瘤性蛛网膜下腔出血患者术后脑积水发生的影响。方法 回顾性分析97例患者临床资料，依据脑脊液引流时间长短及引流量分为短时程、长时程及低流量和高流量组，分析引流时程及引流量对脑积水的影响及关系。结果 97例患者出现脑积水34例、硬膜下积液41例、颅内感染3例。短时程组41例、平均引流时间（10±3.6）d，长时程组56例、平均引流时间（21±4.1）d，组间引流时间差异具统计学意义（P<0.001），组间发生脑积水（22.0% vs 44.6%，P=0.021）、硬膜下积液（26.8% vs 53.6%，P=0.008）差异均具统计学意义，颅内感染差异无统计学意义（3.2% vs 3.6%，P=0.750）。低流量组53例、平均引流量（183±42）ml，高流量组44例、平均引流量（285±34）ml。组间引流量差异具有统计学意义（P<0.001），组间发生脑积水（20.8% vs 52.3%，P=0.001）、硬膜下积液（30.2% vs 56.8%，P=0.008）差异均具统计学意义，颅内感染方面（3.8% vs 2.3%，P=0.067 1）差异无统计学意义。结论 动脉瘤性蛛网膜下腔出血术后脑脊液引流时间、引流量可能是脑积水发生的重要影响因素，长时程及高流量引流脑脊液的患者更易出现脑积水及硬膜下积液。

Abstract:

Objective To investigate the effects of the duration and volume of cerebrospinal fluid drainage through the lumbar cistern on the occurrence of postoperative hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods We retrospectively analyzed the clinical data of 97 patients with aSAH who had continuous cerebrospinal fluid drainage through the lumbar cistern after operation. They were divided into short-term group and long-term group by the duration of drainage, and into low-volume group and high-volume group by the volume of drainage. The relationship between the duration and volume of drainage and hydrocephalus was analyzed. Results Of the 97 patients, 34 developed hydrocephalus, 41 developed subdural effusion, and 3 developed intracranial infection. There were 41 cases in the short-term group and 56 cases in the long-term group, and the mean duration of drainage was significantly shorter in the short-term group than in the long-term group (10±3.6 days vs 21±4.1 days, P<0.001). The long-term group had significantly higher incidence rates of hydrocephalus (44.6% vs 22.0%, P=0.021) and subdural effusion (53.6% vs 26.8%, P=0.008) than the short-term group; there was no significant difference in intracranial infection between the two groups (3.6% vs 3.2%, P=0.750). There were 53 cases in the low-volume group and 44 cases in the high-volume group, and the mean drainage volume was significantly lower in the low-volume group than in the high-volume group (183±42 ml vs 285±34 ml, P<0.001). The high-volume group showed significantly more frequent hydrocephalus (52.3% vs 20.8%, P=0.001) and subdural effusion (56.8% vs 30.2%, P=0.008) compared with the low-volume group; no significant difference was observed in intracranial infection between the two groups (2.3% vs 3.8%, P=0.0671). Conclusions Long duration and high volume of cerebrospinal fluid drainage are associated with the occurrence of hydrocephalus and subdural effusion post operation in patients with aSAH.