Wolf Stefan
Department of Neurosurgery, Charite University Medicine, Berlin, Germany.
Curr Opin Crit Care. 2015 Apr;21(2):120-6. doi: 10.1097/MCC.0000000000000183.
The amount of blood in the basal cisterns is predictive for the final outcome after aneurysmal subarachnoid hemorrhage (SAH) and clinical problems such as delayed cerebral ischemia and angiographic vasospasm. A lumbar drainage presents an additional, physiologically appealing treatment. In contrast to an external ventricular drain, stasis of clots is thought to be prevented and clearance of the basal cisterns accelerated. In theory, patients with higher clinical grades and dense layers of subarachnoid blood should benefit most.
A positive signal but so far no conclusive evidence for lumbar drains in SAH is available from retrospective data. Two large series exist, one after clipping and one after endovascular coiling of the aneurysm leading to the index hemorrhage. The only high-quality large prospective trial failed to prove a better neurologic outcome at 6 months, but investigated predominantly good grade patients with less severe hemorrhage. Further data from another phase III trial is still pending. A concern on the safety of lumbar drains is not supported.
At present, no definite conclusions and recommendations on lumbar drains in patients after aneurysmal SAH are warranted.
基底池内的血量可预测动脉瘤性蛛网膜下腔出血（SAH）后的最终结局以及诸如迟发性脑缺血和血管造影血管痉挛等临床问题。腰大池引流是一种额外的、具有生理吸引力的治疗方法。与脑室外引流相比，腰大池引流被认为可防止血凝块淤积并加速基底池内血凝块的清除。理论上，临床分级较高且蛛网膜下腔出血层较厚的患者受益最大。
回顾性数据显示腰大池引流有阳性信号，但目前尚无确凿证据。有两个大型系列研究，一个是在动脉瘤夹闭术后，另一个是在导致此次出血的动脉瘤血管内栓塞术后。唯一一项高质量的大型前瞻性试验未能证明在6个月时神经功能结局更好，且该试验主要研究的是出血不太严重的病情较轻的患者。另一项III期试验的进一步数据仍未得出。关于腰大池引流安全性的担忧缺乏依据。
目前，对于动脉瘤性SAH患者使用腰大池引流，尚无明确的结论和建议。
