脑脊液引流方式对aSAH后分流依赖性脑积水的影响

Effect of Cerebrospinal Fluid Drainage Methods on Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage

摘要: 目的：讨论动脉瘤性蛛网膜下腔出血(aSAH)后行不同脑脊液引流方式对发生分流依赖性脑积水(SDH)的影响。方法：回顾性分析收治的176例aSAH患者的临床资料，根据是否发生SDH将患者分为发生SDH组(24例)和未发生SDH组(152例)。评估影响SDH发生的危险因素，以及不同脑脊液引流方式对SDH发生以及不同预后的影响。结果：Logistic回归分析提示：高龄、入院低GCS评分、动脉瘤再出血、行脑室外引流为发生SDH的独立危险因素。其中术后行1~2次腰椎穿刺组发生SDH概率最低，但与未行脑脊液引流组比较，差异无统计学差异(OR = 1.26, P = 0.761)。结论：合并发生SDH的危险因素的aSAH患者需关注术后3个月内及长期的随访，及时发现可能的并发症，发生SDH时需个性化选择恰当的脑脊液引流方式。

Abstract: Objective: To discuss the influence of different cerebrospinal fluid drainage methods on the occurrence of shunt-dependent hydrocephalus (SDH) after aneurysmal subarachnoid hemorrhage (aSAH). Methods: The clinical data of 176 patients with aSAH were analyzed retrospectively. They were divided into two groups: patients with SDH (n = 24) and patients without SDH (n = 152). Univariate analysis and logistic regression analysis were performed to evaluate the risk factors of SDH and the effect of different cerebrospinal fluid drainage methods. Results: Logistic regression analysis showed that the independent risk factors of SDH were old age, low GCS score on admission, rebleeding of aneurysm, and method of CSF drainage. The morbidity of SDH was the lowest in the patients with 1 or 2 times lumbar puncture after operation, but there was no significant difference between those and the group without any cerebrospinal fluid drainage (OR = 1.26, P = 0.761). Conclusion: It is particularly significant to choose an appropriate cerebrospinal fluid drainage method during the perioperative period of aSAH. Patients with risk factors need to be closely monitored on the follow-up especially within 3 months after the operation to identify and deal with possible complications in time.