腰大池置管引流脑脊液置换治疗蛛网膜下腔出血的并发症及处理

Complications of continued lumbar cerebrospinal fluid drainage for treatment of subarachnoid hemorrhage and countermeasures

摘要:

探讨腰大池置管引流脑脊液置换治疗蛛网膜下腔出血并发症出现的原因及处理对策。方法收集2014 年12 月-2015 年12 月河南省南阳市中心医院应用腰大池置管脑脊液置换治疗蛛网膜下腔出血63例病例资料，回顾分析所有患者腰大池置管引流效果及并发症发生况。结果留管时间1～29 d，平均（5.87±1.04）d。症状改善情况：显效43 例，有效17 例，无效3 例。并发症：无并发症22 例，脑疝1 例，再次脑出血2 例，迟发型脑积水3 例，置管失败3 例，低颅压6 例，堵管15 例，自拔管6 例，拔管后术口渗液5 例，引流不 畅6 例，硬膜下积液1 例，神经根痛3 例。结论腰大池置管引流能快速引流血性脑脊液，缩短蛛网膜下腔出血患者的治疗时间，提高患者的恢复，并发症发生原因主要包括操作不当、置管不当、引流过度、患者依从性低等，临床工作中应根据不同并发症的发生原因采取相应处理措施，包括提高操作技能、注意控制引流量和引流时间、提高患者依从性等，以降低并发症的发生率。

Abstract:

To research the cause and countermeasure of complications of continued lumbar cerebrospinal fluid drainage (CLCFD) for the treatment of subarachnoid hemorrhage (SAH). Methods The clinical data of 63 patients with SAH who were hospitalized in the Department of Neurosurgery of our hospital from December 2014 to December 2015 were retrospectively analyzed. All of them were be treated by CLCFD, and the effect and complications of CLCFD were observed. Results The time of drainage were 1-29 days with an average of (5.87 ±1.04) days. After treatment 43 cases recovered excellently, 17 cases recovered partially, 3 cases had no improvement. There was no complication in 22 cases, 1 case had cerebral hernia, 2 cases had rebleeding, 3 cases had delayed hydrocephalus, 3 cases failed in intubation, 6 cases had intracranial hypotension. Catheter blockage occurred 15 cases, 6 cases made bold to draw the tube by themselves, 5 cases had seepage, 6 cases had inadequate drainage, subdural effusion occurred in 1 case, radiculalgia occurred in 3 cases. Conclusions Lumbar cistern set tube drainage can rapidly drain bloody cerebrospinal fluid, shorten the duration of treatment for patients with subarachnoid hemorrhage and accelerate patient recovery. The causes of complications include improper operation and catheterization, excessive drainage, and patients with low compliance. According to the different causes of the complications, corresponding measures should be taken in clinic to decrease the incidences of the complications, which include improvement of operation skills, paying attention to control drainage rate and drainage time, and improvement of the patients' compliance.