摘要目的 分析在颅内动脉瘤手术治疗过程中,腰大池持续引流相对于反复腰椎穿刺引流的优缺点.方法 对295例颅内动脉瘤破裂手术治疗病例进行回顾性分析.研究腰大池引流组与反复腰穿引流组在迟发性脑缺血、术后脑积水、术后颅内感染发生率方面的差异.改良Rankin量表(modified Rankin scale,mRS)评分分析两组患者预后的差异.结果 腰大池引流组患者术后迟发性脑缺血发生率4.38％ (7/160),术后脑积水发生率2.50％(4/160).反复腰穿引流组分别为7.41％(10/135)及3.70％(5/135),差异无统计学意义(P＞0.05).术后颅内感染发生率腰大池引流组8.13％(13/160),反复腰穿引流组2.22％(3/135),差异有统计学意义(P＜0.05).mRS评分差异无统计学意义(P＞0.05).结论 在减少术后并发症方面,腰大池持续引流术相对于反复腰穿引流无显著优势,可能增加感染率.故需严格把握指征,进一步规范操作.

abstractsObjective To compare the advantages and disadvantages of continuous lumbar cerebrospinal fluid drainage and repeated lumbar puncture for ruptured intracranial aneurysm surgery.Methods 295 patients were enrolled who had ruptured intracranial aneurysm and were treated surgically between Jan 2010 and Jan 2011 in department of neurosurgery.Patients were classified into 2 groups:patients who were performed with continuous lumbar cerebrospinal fluid drainage (group A) and patients who were performed with repeated lumbar puncture (group B).The incidence rates of major surgical complications of both groups were compared and analyzed,including delayed cerebral ischemia,postsurgical hydrocephalus and postsurgical intracranial infection.All patients were followed-up for over 6 months and the surgical outcomes were assessed using modified Rankin scale (mRS).Results The incidence rates of delayed cerebral ischemia were 4.38％ (7/160) and 7.41％ (10/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of postsurgical hydrocephalus were 2.50％ (4/160) and 3.70％ (5/135) in group A and B respectively.There was no significant difference between 2 groups.The incidence rates of intracranial infection were 8.13％ (13/160) and 2.22％ (3/135) in group A and B respectively.There was a higher rate of intracranial infection in group A (P ＜ 0.05).There was no significant difference in mRS between 2 groups after 6-months follow-up.Conclusions Continuous lumbar cerebrospinal fluid drainage showed little advantage over repeated lumbar puncture in reducing the occurrence of major surgical complications,including delayed cerebral ischemia and postsurgical hydrocephalus.While continuous lumbar cerebrospinal fluid drainage had a higher incidence rate of intracranial infection.Continuous Lumbar cerebrospinal fluid drainage might enhance the risk of intracranial infection.The therapeutic indications of continuous lumbar cerebrospinal fluid drainage for ruptured intracranial aneurysm surgery should be considered carefully.The standardized surgical operations should be followed strictly and the importance of asepsis during the surgery should be valued.