腰大池引流预防颅内动脉瘤破裂出血术后脑积水的研究及其预后影响因素分析

Study on Lumbar Cistern Drainage for Preventing Postoperative Hydrocephalus af-ter Rupture of Intracranial Aneurysm and Analysis of Prognostic Influencing Factors

摘要: 目的：探讨腰大池引流防治颅内动脉瘤破裂出血术后脑积水的研究及预后因素分析。方法：回顾性分析我院2018年至2021年收治的颅内动脉瘤破裂出血患者76例，根据是否接受腰大池引流分为穿刺组和引流组各38例，穿刺组采取常规穿刺治疗，引流组采取腰大池引流术，比较两组治疗前后格拉斯哥评分、疼痛程度VAS评分、脑血流速度水平、颅内压情况、术后并发症情况等。结果：引流组格拉斯哥评分，头疼程度评分明显低于穿刺组组(P < 0.05)，术前颅内压比较，差异无统计学意义(P > 0.05)；术后7 d，引流术组/颅内压低于穿刺术组，差异有统计学意义(P < 0.05)，腰大池引流组术后6月脑积水发生率明显低于穿刺组(P < 0.05)。患者Hunt-Hess分级III~V级、术后脑积水、迟发性脑梗死患者的预后不良率更高(P < 0.05)。结论：腰大池引流可有效预防颅内动脉瘤破裂出血术后脑积水发生，减轻患者头痛，降低颅内压，患者年龄、Hunt-Hess分级、术后脑积水是影响其预后的重要因素。

Abstract: Objective: The aim of this study was to investigate the effect of lumbar cistern drainage on the pre-vention and treatment of postoperative hydrocephalus after rupture of intracranial aneurysms and to analyze the prognostic factors related to this condition. Methods: A retrospective analysis of 76 patients with ruptured intracranial aneurysms who were admitted to our hospital from 2018 to 2021 was conducted. According to whether they received lumbar cistern drainage or not, they were divided into two groups: puncture group and drainage group, each consisting of 38 cases. The puncture group received conventional puncture treatment, while the drainage group received lumbar cistern drainage. The following indicators were compared between the two groups before and after treatment: Glasgow score, pain degree VAS score, cerebral blood flow velocity, intracranial pressure, postoperative complications, and clinical outcomes. Results: The Glasgow score and headache degree score of the drainage group were significantly lower than those of the puncture group (P < 0.05), indicating a better neurological function and a lower pain level in the drainage group. There was no significant difference in intracranial pressure between the two groups before surgery (P > 0.05), suggesting that both groups had similar baseline characteristics. However, after 7 days of surgery, the intracranial pressure of the drainage group was significantly lower than that of the puncture group (P < 0.05), demonstrating that lumbar cistern drainage could effectively re-duce the intracranial pressure and prevent the development of hydrocephalus. The incidence of hydrocephalus in the lumbar drainage group 6 months after surgery was significantly lower than that in the puncture group (P < 0.05). Patients with Hunt-Hess grade III to V, postoperative hydro-cephalus, and delayed cerebral infarction had a higher rate of poor prognosis (P < 0.05). Conclusion: Lumbar cistern drainage can effectively prevent the occurrence of postoperative hydrocephalus af-ter rupture of intracranial aneurysms, reduce the headache of patients, and lower the intracranial pressure. The age, Hunt-Hess grade, and postoperative hydrocephalus of the patients are important factors affecting their prognosis.