Effect Of Early Cerebro-spinal Fluid Drainage After Aneurysm Clipping On Cerebral Vasospasm Of Subarachnoid Hemorrhage Patients

Objective: To investigate the effect of early cerebro-spinal fluid drainage after aneurysm clipping on cerebral vasospasm of aneurysmal subarachnoid hemorrhage(a SAH) patients, in order to make clinical treatment strategies.Methods: 116 aneurysmal subarachnoid hemorrhage patients who were treated with clipping in Handan Central Hospital neurosurgery department between 2009 and 2013 were divided into two groups randomly. Patients in two groups were treated differently. There were 58 patients in CSF(cerebro-spinal fluid)drainage group(group A) and 58 patients in control group(group B). Patients died within a month after clipping aneurysm were not counted. Patients in Group A were placed a drainage tube in the carotid pool after clipping aneurysm, and then suture the dura. We daily drained cerebrospinal fluid and unplug it during 24-48 h. Patients in group B were sutured dura after clipping the aneurysm. Patients in both groups were treated routinely. Patients were 24 h continous intravenous pumped nimodipine20mg/d for 2 weeks. And payed attention to hydroelectrolyte balance;nutrition support and the prevention and treatment of complications. Patients all took CT scan once a week before discharged to judge hydrocephalus situation. Examine the middle cerebral artery(MCA) blood flow velocity on the operation side with transcranial Doppler ultrasound facility on the first,third, fifth, seventh, tenth, fourteenth days. So the cerebral vasospasm(CVS)condition was observed according to the cerebral blood flow. Also recorded postoperative Glasgow outcome scores(GOS) in the six-months follow-up.Results:1 By observing the value of average blood flow velocity of MCA after surgery at main time points, we have found that average velocity of treatmentgroup was significantly reduced comparing to the observation group(t=2.523,P<0.05).2 The time of microscopic examination negativity of red blood cells in CSF in treatment group was significantly reduced comparing to the observation group, with statistical differences(t=2.262, P<0.05).3 3 patients presented with hydrocephalus. 2 cases occured within 1 week,and 1 cases occurred beyond 2 weeks after the operation in the treatment group; 14 patients presented with hydrocephalus. 8 cases occured within 1week, and 6 cases occurred beyond 2 weeks after the operation in the the control group. There is statistical significance between the two groups(x2 =8.340, P <0.05).4 The treatment group is 75.9% with favorable outcome(44/58), and favorable outcome is 48.3%(28/58) in the treatment group with statistical significantce(x2=3.84,P<0.05).Conclusions:1 Early postoperative cerebrospinal fluid drainage in carotid pool will help patients with aneurysmal subarachnoid hemorrhage quickly discharge red blood cells in CSF and significantly reduce the occurrence of vasospasm and hydrocephalus.2 In patients with aneurysmal subarachnoid hemorrhage, early postoperative cerebrospinal fluid drainage in carotid pool can significantly improve the prognosis.