脑室外引流联合尿激酶灌洗在较高分级动脉瘤性蛛网膜下腔出血介入治疗术中的应用

Application of external ventricular drainage combined with urokinase lavage in interventional treatment of high-grade aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨脑室外引流联合尿激酶灌洗在较高分级动脉瘤性蛛网膜下腔出血（aSAH）介入治疗术中的临床疗效。方法 前瞻性纳入2020年1月—2025年3月汉中市中心医院神经外科一病区进行介入栓塞治疗后较高分级aSAH患者65例，随机分为脑室外引流+尿激酶灌洗组（n=34）和单纯脑室外引流组（n=31），比较两组基线资料、并发症及预后。结果 与单纯脑室外引流组相比，脑室外引流+尿激酶灌洗组术后第3天蛛网膜下腔出血清除率增高（P<0.001）；迟发性脑缺血（P=0.018）、脑积水（P=0.018）、继发性癫痫（P=0.036）发生率降低；出院时格拉斯哥昏迷评分更高（P<0.001）；住院时间更短（P<0.001）；出院3个月时改良Rankin量表评分更低（P<0.001）。结论 脑室外引流联合尿激酶冲洗可降低较高分级aSAH介入栓塞治疗术后患者的并发症发生率，而不增加颅内感染风险，可改善神经功能预后。

Abstract:

Objective To investigate the clinical efficacy of external ventricular drainage （EVD） combined with urokinase lavage in the interventional treatment of high-grade aneurysmal subarachnoid hemorrhage （aSAH）.Methods A prospective cohort study was conducted among 65 patients with high-grade aSAH who were admitted to First Ward Area of Department of Neurosurgery， Hanzhong Central Hospital， from January 2020 to March 2025 and underwent interventional embolization therapy. The patients were randomly divided into EVD+urokinase lavage group with 34 patients and EVD group with 31 patients， and the two groups were compared in terms of baseline data， complications， and prognosis.Results Compared with the EVD group， the EVD+urokinase group had a significantly higher clearance rate of subarachnoid hemorrhage on day 3 after surgery （P<0.001）， significantly lower incidence rates of delayed cerebral ischemia （P=0.018）， hydrocephalus （P=0.018）， and secondary epilepsy （P=0.036）， a significantly higher Glasgow Coma Score at discharge （P<0.001）， a significantly shorter length of hospital stay （P<0.001）， and a significantly lower modified Rankin Scale score at 3 months （P<0.001）.Conclusion EVD combined with urokinase lavage can reduce the incidence rates of complications after interventional embolization therapy in patients with high-grade aSAH， without increasing the risk of intracranial infection， thereby improving neurological function prognosis.