Department of Internal Medicine, Puai Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurosurgery, Union Hospital, Tongji Medical College, Wuhan, China.
World Neurosurg. 2021 Jul;151:e1-e9. doi: 10.1016/j.wneu.2021.02.025. Epub 2021 Mar 15.
For aSAH patients with external ventricular drainage (EVD) because of hydrocephalus, the consensus on application of CSF drainage from the lumbar cistern is mixed owing to concerns about its safety and questionable effectiveness. This study evaluated the additional effectiveness of CSF drainage from the lumbar cistern in aSAH patients with EVD.
This was a retrospective and observational study of adult patients with aSAH who were admitted to the intensive care unit at the Wuhan Union Hospital between June 2018 and June 2019. Three aSAH patients with EVD and serial lumbar punctures (LPs) were selected for comparison of CSF components. Four more aSAH patients who underwent divergent CSF drainage were selected to profile the additional effectiveness of lumbar cistern drainage in aSAH patients with EVD.
Cases 1-3 with EVD and serial LPs showed dramatically higher red blood cell (RBC) and leukocyte counts with steeper changing curve in the lumbar cistern CSF than in the ventricle CSF. Case 5 had EVD alone and showed a slower clearing rate of blood clot in subarachnoid space compared with case 1. Case 4, with serial LPs alone, showed a steep changing curve of both RBC and leukocyte counts in the lumbar cistern CSF. Cases 6 and 7, with EVD and follow-up LPs, showed dramatically higher RBC and leukocyte counts in the lumbar cistern CSF than in the ventricle CSF after almost 2 weeks of EVD.
For aSAH patients with EVD, serial LPs can accelerate clearance of toxic products from the subarachnoid space.
对于因脑积水而接受外部脑室引流 (EVD) 的 aSAH 患者，由于对其安全性和有效性的担忧，腰椎穿刺 (LP) 引流脑脊液的共识存在分歧。本研究评估了 EVD 的 aSAH 患者腰椎穿刺引流脑脊液的额外效果。
这是一项回顾性观察性研究，纳入了 2018 年 6 月至 2019 年 6 月期间入住武汉协和医院重症监护病房的成年 aSAH 患者。选择 3 例 EVD 并进行连续 LP 的 aSAH 患者进行脑脊液成分比较。选择另外 4 例接受不同脑脊液引流的 aSAH 患者，以评估 EVD 的 aSAH 患者腰椎穿刺引流脑脊液的额外效果。
EVD 并进行连续 LP 的病例 1-3 的腰椎穿刺脑脊液中的红细胞 (RBC) 和白细胞计数明显更高，变化曲线更陡峭，而脑室脑脊液中的 RBC 和白细胞计数变化曲线则较为平缓。病例 5 仅行 EVD，与病例 1 相比，蛛网膜下腔中的血凝块清除速度较慢。病例 4 仅进行连续 LP，腰椎穿刺脑脊液中的 RBC 和白细胞计数变化曲线陡峭。EVD 并进行后续 LP 的病例 6 和 7，在接受 EVD 治疗近 2 周后，腰椎穿刺脑脊液中的 RBC 和白细胞计数明显高于脑室脑脊液。
对于 EVD 的 aSAH 患者，连续 LP 可以加速蛛网膜下腔有毒物质的清除。
