Study of clinical effect of lumbar puncture drainage in patients with subarachnoid hemorrhage

Zhang Yuzhen; Wang Yunliang; Lou Jiyu; Zeng Zhilei; Li Jinfeng; Zhang Hui; Tian Daishi

doi:10.3760/cma.j.issn.1673-4777.2014.08.015

Abstract：Objective To explore the effect of continuous lumbar puncture drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage (aSAH) on delayed ischemic neurological deficit (DIND).Methods From January 2006 to June 2013,305 patients with aSAH were recruited from the 148 Hospital and the Second Affiliated Hospital of Zhengzhou University.According to World Federation of Neurological Surgeons (WFNS) grade 1 to 3 aSAH and modified Fisher grades 2,3,4,patients were randomly divided into the study group and the control group.The study group was given standard therapy plus lumbar drain and the control group was given standard therapy only.The primary observation was the prevalence of DIND and clinical improvement.Results The prevalence of DIND was 21.1％ (32/152) and 36.6％ (56/153) in the study group and in control group; there was significant difference of the incidence of delayed ischemic neurological functional defect between two groups (P =0.018).The average 24 h drainage volume of study group was (135 ± 14)ml and the average drainage time was (5.2 ± 1.1)d.Focal ischemia and the disturbance of consciousness in study group were notably lower than those in the control group[8.5％ (13/152) vs 20.9％ (32/153),7.2％ (11/152) vs 9.2％ (14/153)] (P =0.015,P =0.015) ; the incidence of cerebral infarction was lower than that in the control group [23.3％ (35/152) vs 31.2％ (48/153)] (P =0.036) ; the proportion of patients who needed continuous cerebrospinal fluid peritoneal shunt was lower than that in the control group[4.6％ (7/152) vs 7.8％ (12/153)](P =0.024).At day 10 and 6 month,a modified Rankin Scale score in the study group was 55.3％ (84/152) and 81.6％ (124/152) ; it was 34.6％ (53/153)and 80.4％ (123/153) in the control group.Conclusion Continuous lumbar puncture drainage of cerebrospinal fluid after aSAH can reduce the prevalence of DIND and improve early clinical outcome,but there is no influence at 6 months after aSAH.