王伟丰　杨瑞生　黄春波

[摘要] 目的 探讨持续腰大池引流术引流与多次腰椎穿刺术引流治疗重型颅脑损伤合并蛛网膜下腔出血的效果。方法 随机选取入医院治疗的重型颅脑损伤合并蛛网膜下腔出血患者70例作为研究对象，采用数字随机法将患者分为对照组和观察组，对照组行多次腰椎穿刺术引流治疗，观察组采用持续腰大池引流术引流治疗，行格拉斯哥昏迷评分（GCS）、格拉斯哥预后评分（GOS），记录脑脊液红细胞计数低于100×106/L的时间，观察术后1个月内并发症发生率。结果 观察组治疗后GCS为（12.52±1.51）分显著高于对照组，脑脊液红细胞<100×106/L时间为（7.24±1.53）d显著短于对照组，差异有统计学意义（P<0.05）。观察组治疗后1个月内癫痫、脑积水、脑梗死的发病率分别为0.0%、5.71%、2.86%显著低于对照组11.43%、22.86%、22.86%，差异有统计学意义（P<0.05）。观察组良好率为57.14%明显高于对照组31.43%，死亡率为0.0%明显低于对照组14.29%，差异有统计学意义（P<0.05）。 结论 持续腰大池引流术引流能够缩短引流时间，降低术后并发症发生率，可改善患者预后。

[关键词] 颅脑损伤；蛛网膜下腔出血；持续腰大池引流术引流；格拉斯哥昏迷评分

[中图分类号] R651.15 [文献标识码] A [文章编号] 1674-0742（2015）04（c）-0015-03

[Abstract] Objective To study the effect of the continuous lumbar cistern drainage and drainage with lumbar puncture and drainage in the treatment of multiple injury complicated with subarachnoid hemorrhage and severe craniocerebral. Methods Selected combined subarachnoid hemorrhage in 70 cases as the object of study into the hospital for treatment of severe craniocerebral injury， by using randomly were divided into the observation group and the control group， the control group underwent repeated lumbar puncture drainage treatment， the observation group with continuous lumbar cistern drainage drainage treatment， for Glasgow coma score（GCS）， Glasgow Outcome Scale （GOS）， recording the cerebrospinal fluid red blood cell count of less than 100×106/L time， observed the rate of complications within 1 month. Results In observation group after treatment， GCS（12.52±1.51）was significantly lower than that of the control group， CSF erythrocyte < 100×106/L time was（7.24±1.53）days， which was significantly shorter than the control group， the difference was statistically significant（P<0.05）. Observation of 1 months of epilepsy， hydrocephalus， cerebral infarction group after treatment， the incidence rates were 0%， 5.71%， 2.86%， which were significantly lower than the control group 11.43%， 22.86%， 22.86%， the differences were statistically significant（P<0.05）. Good rate was 57.14% in observation group was significantly higher than the control group 31.43%， mortality of 0% was lower than that of the control group 14.29%， the difference was statistically significant（P<0.05）. Conclusion Continuous lumbar cistern drainage drainage can shorten the drainage time， reduce the incidence of postoperative complications， which can improve the prognosis of the patients.

[Key words] Craniocerebral injury； Subarachnoid hemorrhage； Continuous lumbar cistern drainage drainage； Glasgow coma score

外伤行蛛网膜下腔出血（tSAH）是颅脑损伤常见并发症，重型颅脑损伤合并tSAH的发病率为35%～60%，若治疗不当，可能诱发脑缺血、脑梗死、脑水肿等，甚至死亡[1]。以往常采用多次腰椎穿刺术引流治疗重型颅脑损伤合并tSAH，但反复穿刺不仅会增加患者不适感，还可能诱发颅内感染。有文献指出，与多次腰椎穿刺术引流相比，持续腰大池引流术引流手术创伤小，能够减少穿刺次数，可提高临床治疗效果。对此，文章对比分析了持续腰大池引流术引流与多次腰椎穿刺术引流对重型颅脑损伤合并tSAH患者GCS评分、并发症等影响，以改善预后，现分析2012年6月—2014年6月间入医院治疗的重度颅脑损伤合并tSAH患者70例的临床资料，现报道如下。

1 资料与……