Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, Texas;
J Neurosurg. 2013 Oct;119(4):974-80. doi: 10.3171/2013.6.JNS122403. Epub 2013 Aug 20.
Cerebral artery vasospasm is a major cause of death and disability in patients recovering from subarachnoid hemorrhage (SAH). Although the exact cause of vasospasm is unknown, one body of research suggests that clearing blood products by CSF drainage is associated with a lower frequency and severity of vasospasm. There are multiple approaches to facilitating CSF drainage, but there is inadequate evidence to determine the best practice. The purpose of this study was to explore whether continuous or intermittent CSF drainage was superior for reducing vasospasm.
The authors performed a randomized clinical trial. Within 72 hours of admission for SAH, patients with an external ventricular drain (EVD) were randomized to undergo continuous CSF drainage with intermittent intracranial pressure (ICP) monitoring (open-EVD group) or continuous ICP monitoring with intermittent CSF drainage (monitor-ICP group).
After 60 patients completed the study, an interim analysis was performed. The complication rate of 52.9% for the open-EVD group was significantly higher than the 23.1% complication rate for the monitor-ICP group (OR 3.75, 95% CI 1.21-11.66, p = 0.022). These results were reported to the Data Safety and Monitoring Board and enrollment was terminated. The odds ratio of vasospasm for the open-EVD versus monitor-ICP group was not significant (OR 0.44, 95% CI 0.13-1.45, p = 0.177).
Continuous CSF drainage with intermittent ICP monitoring is associated with a higher rate of complications than continuous ICP monitoring with intermittent CSF drainage, but there is no difference between the two types of monitoring in vasospasm. Clinical trial registration no.: NCT01169454 (clinicaltrials.gov).
脑动脉痉挛是蛛网膜下腔出血（SAH）患者死亡和残疾的主要原因。尽管血管痉挛的确切原因尚不清楚，但有研究表明，通过脑脊液引流清除血液产物与较低的血管痉挛频率和严重程度相关。有多种方法可以促进脑脊液引流，但没有足够的证据来确定最佳实践。本研究旨在探讨连续或间歇性脑脊液引流在降低血管痉挛方面是否更具优势。
作者进行了一项随机临床试验。在 SAH 入院后 72 小时内，将带有外部脑室引流管（EVD）的患者随机分为连续脑脊液引流并间歇性颅内压（ICP）监测（开放-EVD 组）或连续 ICP 监测并间歇性脑脊液引流（监测-ICP 组）。
在 60 名患者完成研究后，进行了中期分析。开放-EVD 组的并发症发生率为 52.9%，明显高于监测-ICP 组的 23.1%（OR 3.75，95%CI 1.21-11.66，p=0.022）。这些结果报告给了数据安全和监测委员会，研究因此停止。开放-EVD 与监测-ICP 组的血管痉挛比值比无显著差异（OR 0.44，95%CI 0.13-1.45，p=0.177）。
与连续 ICP 监测伴间歇性脑脊液引流相比，连续脑脊液引流伴间歇性 ICP 监测与更高的并发症发生率相关，但两种监测方法在血管痉挛方面没有差异。临床试验注册号：NCT01169454（clinicaltrials.gov）。
