Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2022 Oct;166:261-267.e9. doi: 10.1016/j.wneu.2022.07.061. Epub 2022 Jul 20.
This study reviews the use of lumbar drains (LDs) after aneurysmal subarachnoid hemorrhage (aSAH) and compares the outcomes to those associated with external ventricular drains (EVDs) and controls.
A comprehensive search of the literature was performed. English language studies with a sample size of more than 10 patients were included. One-arm and 2-arm meta-analyses were designed to compare external drainage groups. Random-effects models, heterogeneity measures, and risk of bias were calculated.
Seventeen studies were included in the meta-analysis. The 2-arm meta-analysis comparing the LD to no drainage after aSAH found a significant improvement in the postoperative modified Rankin Scale (mRS) score (0-2) within 1 month of hospital discharge in the LD group (P = 0.003), a lower mortality rate (P = 0.03), fewer cases of clinical vasospasm (P = 0.007), and a lower incidence of ischemic stroke or delayed ischemic neurological deficits (P = 0.003). When the LD was compared to EVDs, a significant improvement in the postoperative mRS score (0-2) within 1 month of discharge was found in the LD group (P < 0.001). In the LD group, rebleeding occurred in 15 (3.4%) cases and meningitis occurred in 50 (4.7%) cases.
Compared with patients without cerebrospinal fluid drainage, patients with the LD after aSAH had lower mortality rates, lower risk of clinical vasospasm, and lower risk of ischemic stroke, and they were more likely to have an mRS score of 0-2 within 1 month of discharge. Compared with patients with EVDs, patients with the LD were more likely to have an mRS score of 0-2 within 1 month of discharge.
本研究回顾了腰大池引流（LDs）在颅内动脉瘤性蛛网膜下腔出血（aSAH）后的应用，并将其结果与外部脑室引流（EVDs）和对照组进行比较。
对文献进行了全面检索。纳入了样本量超过 10 例的英语语言研究。设计了单臂和双臂荟萃分析来比较外部引流组。计算了随机效应模型、异质性测量和偏倚风险。
17 项研究纳入荟萃分析。与 aSAH 后不引流相比，2 臂荟萃分析发现 LD 组在出院后 1 个月内术后改良 Rankin 量表（mRS）评分（0-2）显著改善（P=0.003），死亡率较低（P=0.03），临床血管痉挛病例较少（P=0.007），缺血性卒中和迟发性缺血性神经功能缺损发生率较低（P=0.003）。与 EVDs 相比，LD 组在出院后 1 个月内术后 mRS 评分（0-2）显著改善（P<0.001）。在 LD 组中，再出血发生在 15 例（3.4%），脑膜炎发生在 50 例（4.7%）。
与无脑脊液引流的患者相比，aSAH 后接受 LD 的患者死亡率较低，临床血管痉挛风险较低，缺血性卒中风险较低，出院后 1 个月内 mRS 评分（0-2）的可能性较高。与 EVDs 患者相比，LD 患者出院后 1 个月内 mRS 评分（0-2）的可能性较高。
