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投稿时间：2019-10-23 网络发布日期：2020-06-20
投稿时间：2019-10-23 网络发布日期：2020-06-20
中文摘要: 目的 探究PICC管腰大池穿刺置管持续引流辅助血管内弹簧圈栓塞术治疗颅内破裂动脉瘤的疗效及对血清神经元特异性烯醇化酶(NSE)、髓鞘碱性蛋白(MBP)水平的影响。方法 选取2017年1月至2018年6月颅内破裂动脉瘤患者84例作为研究对象,简单随机化分组,各42例。两组均行血管内弹簧圈栓塞术,对照组术后给予腰椎穿刺引流,研究组术后给予PICC管腰大池穿刺置管持续引流。比较两组手术前后脑脊液压力、红细胞计数(RBC)、大脑中动脉血流速度(VMCA)、血清NSE、MBP水平及并发症发生率,并随访6个月,统计对比两组预后情况。结果 研究组术后3 d、5 d、7 d脑脊液压力、RBC低于对照组(P<0.05)。两组术后3 d、5 d VMCA较术前升高,术后7 d开始逐渐降低,研究组术后14 d恢复至术前水平,且研究组术后3 d、5 d、7 d、14 d VMCA低于对照组(P<0.05)。研究组术后7 d、14 d血清NSE、MBP水平低于对照组(P<0.05)。研究组并发症发生率9.52%低于对照组的26.19%(P<0.05)。经Ridit检验可知,研究组预后情况优于对照组(P<0.05)。结论 PICC管腰大池穿刺置管持续引流辅助血管内弹簧圈栓塞术治疗颅内破裂动脉瘤患者可显著降低脑脊液压力,加快清除蛛网膜下腔积血,促进大脑中动脉血流速度恢复,还可减轻神经功能损伤,改善预后情况。
中文关键词: 颅内破裂动脉瘤 血管内弹簧圈栓塞术 PICC管 腰大池穿刺置管持续引流 神经元特异性烯醇化酶 髓鞘碱性蛋白
Abstract:Objecitve To investigate the effect of continuous drainage of lumbar cistern with PICC tube and endovascular spring coil embolization in the treatment of ruptured intracranial aneurysms and the effect on the levels of serum neuron specific enolase (NSE) and myelin basic protein (MBP). Methods A total of 84 patients with ruptured intracranial aneurysms from January 2017 to June 2018 were randomly divided into study group and control group (n=42, each).The two groups were treated with endovascular spring coil embolization, the control group with lumbar puncture drainage, the study group with PICC tube for lumbar cistern puncture drainage.The CSF pressure, RBC, VMCA, NSE, MBP and the incidence of complications were compared between the two groups before and after operation. Results The CSF pressure and RBC in the study group were lower than those in the control group on the 3rd, 5th and 7th day after operation (P<0.05).VMCA of the two groups increased on the 3rd and 5th day after operation, and began to decrease on the 7th day after operation(P<0.05).VMCA of the study group returned to the preoperative level on the 14th day after operation, and VMCA of the study group was lower than that of the control group on the 3rd, 5th, 7th and 14th day after operation(P<0.05).The levels of NSE and MBP in the study group were lower than those in the control group on the 7th and 14th day after operation(P<0.05).The incidence of complications in the study group was significantly lower than that in the control group (9.52% vs 26.19%, P<0.05).According to the Ridit test, the prognosis of the study group was better than that of the control group (U=2.034, P=0.042). Conclusion The continuous drainage of lumbar cistern with PICC and endovascular spring coil embolization in the treatment of ruptured intracranial aneurysms can significantly reduce the pressure of cerebrospinal fluid, accelerate the removal of subarachnoid hematocele, promote the recovery of blood flow rate of middle cerebral artery, reduce the damage of nerve function and improve the prognosis.
keywords: Intracranial ruptured aneurysm Endovascular spring coil embolization PICC tube Lumbar cistern puncture and continuous drainage Neuron specific enolase Myelin basic protein
文章编号： 中图分类号： 文献标志码：B
基金项目:国家自然科学基金(81502186)
| Author Name | Affiliation |
| XU Hui, CHEN Hong-zun, ZHANG Lu-hua | Third Surgical Department, Second Naval Hospital of Southern Theater Command, Sanya, Hainan 572000, China |
引用文本：
徐辉,陈宏尊，章露华.PICC管腰大池穿刺置管持续引流辅助血管内弹簧圈栓塞术治疗颅内破裂动脉瘤[J].中国临床研究,2020,33(6):773-777.
徐辉,陈宏尊，章露华.PICC管腰大池穿刺置管持续引流辅助血管内弹簧圈栓塞术治疗颅内破裂动脉瘤[J].中国临床研究,2020,33(6):773-777.