Objective To explore the effectiveness and safety of exchange of cerebrospinal fluid in the treatment of subarachnoid hemorrhage （SAH）. Methods Sixty SAH patients diagnosed by CT and lumbarpuncture were randomly assigned into a control group （n =30, received conventional treatment） and a treatment group （n =30, received exchange of cerebrospinal fluid plus conventional treatment）. The main complications and effectiveness between the two groups were compared. SPSS 10.0 was used for statistical analysis. Results Compared with the control group, complications of persistent headache （ P =0.002 and 0. 007 respectively）, cerebral vasospasm （ P =0. 028 ） and hydrocephalus （ P =0. 038 ） were fewer in the treatment group. No significant difference in the incidence of rehaemorrhagia was found between the two groups （P = 1. 000）. Better effectiveness was observed in the treatment group （RR. 3.00, 95% CI 1. 014 to 8. 880, P = 0. 044 ）. Conclusions Exchange of cerebrospinal fluid plus conventional treatment is more effective than conventional treatment alone in the treatment of SAH.
Objective To investigate the incidence, risk factors and relationship with intraocular hemorrhage of Tersonprime;s syndrome among patients with spontaneous subarachnoid hemorrhage (SSAH) after emergency admission. Methods Seventy-four consecutive patients with SSAH from June 2010 to September 2011 were prospectively examined. A direct ophthalmoscope examination was performed in all participants within three hours after emergency admission. If circumstances permit, fundus photos were taken. When initial fundus examination was conducted, the Hunt-Hess grade was classified by the brain surgeon. The fundus examination was taken on the 1st, 3rd, and 7th day, 2 weeks, 1 month, and 3 months after emergency admission. The details were recorded, including sex, age, bleeding patterns, Hunt-Hess grade and death. The incidence of Tersonprime;s syndrome was analyzed and correlated with sex, age and Hunt-Hess grade. The relationship between intraocular hemorrhage and Hunt-Hess grade and mortality was analyzed. Results Among the 74 patients, 19 were suffering from Tersonprime;s syndrome, 31 eyes involved. The incidence of Tersonprime;s syndrome was 25.7%. Statistical analysis demonstrated that the sex of the patient was randomly distributed (chi;2=0.071,P=0.790), and the age components were also randomly distributed (Fisherprime;s exact test.P=0.203). The Hunt-Hess grade components were nonrandomly distributed (Fisherprime;s exact test，P=0.000). Among the patients with preretinal hemorrhage and vitreous hemorrhage, Hunt-Hess grade Ⅴ was in 76.9% patients; among inte-retinal hemorrhage, Hunt-Hess grade was in 16.7% of patients. The distribution was non-random (Fisherprime;s exact test.P=0.041). All intraocular hemorrhages were found at the time of first fundus examination. The mortality from Tersonprime;s syndrome was 68.4% (13/19) according to the follow-up investigation. The mortality in patients with vitreous hemorrhage and preretinal hemorrhage was statistically different (Fisherprime;s exact test.P=0.046) from patients with inter-retinal hemorrhage. Among the six recovered Tersonprime;s syndrome patients, two of them were recovered from vitrectomy, and the other four were recovered from selfabsorption. Conclusions A higher frequency (25.7%) of Tersonprime;s syndrome was observed in patients with SSAH. The incidence is highly related to the general condition of the patient but not to the sex or age. Intraocular hemorrhage is more likely to happen in the early time of SSAH. People with more severe intraocular hemorrhage may have worse general condition or higher mortality.
Objectives To assess the effectiveness and safety of lumbar continuous drainage of the cerebrospinal fluid therapy for subarachnoid hemorrhage (SAH). Methods The method of Cochrane systematic review was used to evaluate the randomized controlled trials (RCTs) of lumbar contiunous drainage of the cerebrospinal fluid therapy for SAH. Results We included 7 RCTs involving 390 patients. The methodological quality of all the trials was poor. The poor outcome and adverse event evaluation of the SAH patients at the end of long-term follow-up (at least three months) were not reported in all studies. Meta-analysis of fatality showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance [RR=0.32, 95%CI (0.15, 0.70)]. Meta-analysis of complications also showed a better effect of lumbar continuous drainage of the cerebrospinal fluid therapy for SAH than the control group with statistical significance (except re-bleeding) [cerebral vasospasm RR=0.15, 95%CI (0.06, 0.33), hydrocephalus RR=0.22, 95%CI (0.10, 0.52), cerebral infarction RR=0.25, 95%CI (0.08, 0.82)]. Only one trial reported the adverse events of lumbar continuous drainage of the cerebrospinal fluid therapy including intracranial infection and intracranial hypotension reaction, while the other trials did not report the adverse events. Conclusion With poor quality of the most included trials, insufficient evidence is obtained to support the conclusion that lumbar continuous drainage of the cerebrospinal fluid therapy is safe and effective in the treatment of SAH. Further high-quality RCTs should be carried out to provide more reliable evidence.
Objective To identify an evidence-based treatment for a patient with aneurysmal subarachnoid hemorrhage (aSAH). Methods We first put forward clinical problems about how to prevent complications and how to treat ruptured aneurysm of aSAH, then searched The Cochrane Library (Issue 4, 2006), Ovid ACP Journal Club (1991 to 2006), Ovid MEDLINE (1966 to 2006), NGC (1998 to 2006) and CBM (1978 to 2006) to identify systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines. Results Eleven studies and five guidelines were included. Current evidence indicated that nimodipine was effective for prophylaxis of poor outcome after vasospasm, while tirilazad was not effective in female patients with good grades. The effectiveness of other treatments to prevent complications was not clear. Evidence on the use of antifibrinolytics for the prevention of re-bleeding was inconsistent. If a ruptured aneurysm was considered suitable for both surgical clipping and endovascular coiling, coiling was associated with a better outcome. According to the available evidence and guidelines, considering the patient’s conditions and preferences, nimodipine and antifibrinolytics were administered to prevent complications and her aneurysm was treated by early endovascular embolization. She did not experience vasospasm or re-bleeding during her hospital stay. Short-term follow-up showed a good outcome. Long-term prognostic benefits after endovascular therapy need to be confirmed by prolonged follow-up. Conclusions Therapies based on the best clinical evidence and guidelines should be given to prevent complications and improve outcome for patients after an aSAH.
【摘要】 目的 探讨基层医院显微外科手术治疗动脉瘤性蛛网膜下腔出血（aSAH）的手术时机、方法以及疗效。 方法 回顾分析2005年1月-2009年12月经翼点入路行显微外科手术治疗的36例aSAH患者的临床资料。 结果 所有aSAH患者经数字减影血管造影检查确诊，均行瘤颈夹闭术。手术效果按GOS评分，恢复良好30例（83%）、中度残疾4例（11%）、死亡2例（6%）。 结论 aSAH按Hunt-Hess分级为Ⅰ～Ⅱ级的患者应尽早手术， Ⅲ～Ⅳ级应结合患者颅内出血量及全身状况综合考虑，Ⅴ级待病情稳定后积极手术治疗。经翼点入路显微外科手术治疗前循ASAH，手术中暴露清楚，夹闭瘤颈可靠，疗效满意。【Abstract】 Objective To explore the operative time, methods and curative effect of microsurgical treatment on aneurysmal subarachnoid hemorrhage (aSAH) in basic-level hospitals. Methods The data of 36 patients with aSAH who had undergone microsurgery from January 2005 to December 2009, were retrospectively analyzed. Results All the patients were confirmed as aSAH by digital subtraction angiography, and all of them had undergone clapping of aneurism. According to GOS, 30 patients (83%) had good recovery, four patients (11%) had moderate disability and two patients (6%) died. Conclusions The operation should be done as early as possible in the patients with gradeⅠ-Ⅱ of Hunt-Hess, the volume of intracranial hemorrhage and patient’s condition should be considered to decide when to operate of grade Ⅲ-Ⅳ, patients with grade Ⅴ aneurysms should be treated by conservative therapy first. They should consider an operation only when their condition is stable after conservative therapy. The peritoneal approach is a good procedure because of clear exposure, reliable clipping and satisfactory results.
目的：研究脑脊液置换术治疗蛛网膜下腔出血的效果。方法：蛛网膜下腔出血79例为治疗组及30例对照组，给予常规药物治疗，治疗组在此基础上增加脑脊液置换疗法。结果：治疗组疗效优于对照组、治疗有效率及死亡率上差异均有显著。 结论：脑脊液置换术对蛛网膜下腔出血具有较好的疗效，值得进一步推广。