蛛网膜下腔出血合并脑积水的治疗方法探讨

目的:探讨蛛网膜下腔出血(SAH)合并脑积水的治疗方法。方法:回顾性分析31例SAH合并脑积水患者的临床资料,除常规脱水、防治血管痉挛、营养神经等治疗方法外,其中10例给予行脑室-腹腔分流术,21例行侧脑室外引流术,对比分析两种治疗方案的利弊。结果:10例脑室-腹腔分流术患者9例手术效果良好,术后复查颅脑CT显示脑室明显减小,间质水肿消失,1例患者术后1月内再次出现脑积水,给予行同侧分流管探查再通、对侧脑室-腹腔分流术,术后效果良好,颅脑CT示脑室减小。21例行侧脑室外引流术患者,术后感染2例,全部患者均术后7天内拔除引流管,术后1月9例复发脑积水,给予再次行脑室-腹腔分流术,术后效果良好。结论:在手术指征明确的情况下,早期给予SAH合并脑积水患者行脑室腹腔分流术,分流管堵塞可能性小,术后感染发生率低,临床效果令人满意。

A Study on the Therapeutic Methods of Subarachnoid Hemorrhage Combined with Hydrocephalus

Objective:To investigate the therapeutic methods of subarachnoid hemorrhage (SAH) combined with hydrocephalus.Methods:The clinical data of 31 cases of SAH combined with hydrocephalus treated with regular dehydration, prevention and cure of angiospasm, trophic nerve and so on were retrospectively analyzed. The therapeutic effect of ventriculoperitoneal shunts and lateral ventricular drainage were analyzed and compared.Results:In the ventriculoperitoneal shunts group (10 cases), 9 cases (90%) recuperated better and showed a decreased size of cerebral ventricles and disappearance of interstitial edema after operation, 1 case (10%) occurred hydrocephalus again after postoperative for 1 month but ameliorated by detection and recanalization through the ipsilateral shunt pipe and contralateral ventriculoperitoneal shunts. In the lateral ventricular drainage group (21 cases), 2 cases occurred postoperative infection, 9 cases showed hydrocephalus again but ameliorated by ventriculoperitoneal shunts.Conclusion:Ventriculoperitoneal shunts was a valuable and effective approach in the treatment of SAH combined with hydrocephalus, it could reduce the probability of shunt pipe blockage and postoperative infection.