腰大池持续引流在去骨瓣减压术后的应用  

Application of Continuous Cerebrospinal Fluid Drainage after the Inferior Major Bone Flap Craniotomy Decompression

作　　者：华春华 陈国坚[1] 袁荣军 蔡徐杰 朱道平[1] 

机构地区：[1]广东省英德市人民医院,广东英德513000

出　　处：《中国现代医生》2008年第30期21-22,25,共3页China Modern Doctor

摘　　要：目的探讨腰大池持续引流在去骨瓣术后患者中的疗效,提高重型脑损伤病人的生存率。方法于2001年1月～2008年5月,将重型脑损伤颅脑外伤术后的患者分成两组,对照组41例于开颅术后第3天行腰穿放液每天或隔天一次;治疗组35例于开颅术后第3天行腰大池持续引流术。其他治疗相同。结果治疗组和对照组脑脊液中红细胞<100×106/L的时间分别为伤后(5.0±2.5)d和(10±8)d(P<0.01);颅内压恢复正常时间治疗组和对照组分别是伤后(7±3)d和(27±10)d(P<0.01);减压骨窗凹陷时间治疗组和对照组分别为术后(2±1.5)d和(11±3)d(P<0.01);治疗组良好15例,重残5例,死亡8例,对照组良好12例,重残10例,死亡15例,P<0.05。结论腰大池放置引流管,血性脑脊液廓清快,减压骨窗凹陷早,清醒快,并发症发生率明显降低;且死亡率和重残率低,两者有显著性差异。Objective To discuss the curative effect of treatment of continuous cerebrospinal fluid drainage after decompressive craniectomy, and increase the survival rate of severe cerebral injuries. Methods From Junuary 2001 to May 2008,patients of severe craniocerebral trauma postoperatively were divided into therapeutic group and control group randomly. Patients in control group （41 cases） used continuous cerebrospinal fluid drainage after two days postoperatively every day or every two days; patients in therapeutic group （35 cases）used lumber puncture at the same time. All the patients had the same other treaments. Results The time of postoperative amount of RBC reaching less than 100 × 10^6/L was（5.0 ± 2.3）d and（ 10 ± 8）d in therapeutic group and control group respectively（P〈 0.01 ）. The postoperative time of intracranial pressure coming back to normal was （7 ±3 ）d and （27 ±10）d in therapeutic group and control group respectively （P 〈 0.01 ）. The postoperative time of relieving pressure of bone window indentation was （2 ±1.5 ）d and （ 11 ±3 ）d in therapeutic group and control group respectively （P 〈 0.01 ）. In therapeutic group, the well-recuperated patients were 15 cases, severe deformity patients were 5 cases and deaths were 8 cases. In control group,the well-recuperated patients were 12 cases, severe deformity patients were 10 cases and deaths were 15 cases. Conclusion The method of continuous cerebrospinal fluid drainage could clean bloody cerebrospinal fluid more quickly, relieve pressure of bone window indentation sooner,help patients regain consciousness more quickly and decrease the presence rate of intercurrent effect. Besides,the death rate and deformity rate of former group are lower than that of the latter group. There were distinct differences between the two groups.

关 键 词：创伤性蛛网膜下腔出血 去骨瓣减压术 腰大池引流 

分 类 号：R651.1[医药卫生—外科学]