Satoh Akira, Sugiyama Tatsuya, Ooigawa Hidetoshi, Nakajima Hiroyuki, Ogura Takeshi, Neki Hiroaki, Morikawa Eiharu
Department of Neurosurgery, Stroke Center, International Medical Center, Saitama Medical University, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
Acta Neurochir Suppl. 2010;107:115-8. doi: 10.1007/978-3-211-99373-6_19.
Symptomatic vasospasm (SVS) is still a major cause of poor outcome in cases undergoing early surgical intervention for ruptured intracranial aneurysm. Among the numbers of therapeutic trials to prevent and ameliorate neurological deterioration due to SVS, removal or quenching of oxy-hemoglobin (OxyHb) from subarachnoid colts and administration of Mg(2+) (Mg) have especially been expected to be effective. In this report the authors investigated the effect of continuous cisternal irrigation (CCI) with mock CSF containing ascorbic acid (ASA) and Mg, performed after early surgery for ruptured aneurysm.
Sixty-three cases which had received CCI were retrospectively compared with 40 control cases as to the incidence of SVS and outcome.
Incidence of SVS was significantly less frequent (P < 0.05) in the CCI group (11%) than in the control group (25%). Severe and definitive SVS requiring additional specific treatment occurred only in 3.2% of the CCI group, while 22.5% in the control (P < 0.01). Overall outcome at discharge was significantly better in the CCI group than in the control (P < 0.01).
Postoperative CCI with ASA and Mg was definitively effective in preventing SVS and in lessening severity of SVS if it occurs.
症状性血管痉挛（SVS）仍是颅内动脉瘤破裂早期手术干预患者预后不良的主要原因。在众多旨在预防和改善因SVS导致的神经功能恶化的治疗试验中，从蛛网膜下腔清除或淬灭氧合血红蛋白（OxyHb）以及给予镁离子（Mg）尤其被认为可能有效。在本报告中，作者研究了在破裂动脉瘤早期手术后进行的含抗坏血酸（ASA）和Mg的模拟脑脊液持续脑池灌洗（CCI）的效果。
回顾性比较63例接受CCI治疗的患者与40例对照患者的SVS发生率和预后情况。
CCI组的SVS发生率（11%）显著低于对照组（25%）（P < 0.05）。需要额外特殊治疗的严重且明确的SVS仅在CCI组的3.2%患者中出现，而对照组为22.5%（P < 0.01）。出院时CCI组的总体预后明显优于对照组（P < 0.01）。
术后使用ASA和Mg进行CCI对于预防SVS以及减轻SVS（如果发生）的严重程度具有确切疗效。
