腰大池置管外引流联合鞘内注射给药对脑脊液漏合并颅内感染治疗效果研究  

Clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intracranial infection

作　　者：李璞[1] 王增森[1] 李明升[1] 郭宏川[2] 

机构地区：[1]山西省运城市急救中心神经内科,044000 [2]首都医科大学宣武医院神经外科

出　　处：《中国综合临床》2015年第1期66-69,共4页Clinical Medicine of China

摘　　要：目的探讨腰大池置管外引流联合鞘内注射给药在治疗脑脊液漏合并颅内感染中临床效果。方法采用回顾性分析方法，查阅我院2006年至2014年间临床病例资料，共筛选152例病例纳入此次研究，并依据患者后期处理方式不同，将其分为腰椎穿刺＋鞘注组（A组）、腰大池组（B组）及腰大池＋鞘注组（C组），并比较3组治疗前后各实验数据变化、治疗总有效率、治疗有效时间、细菌清除率及安全性差异。结果治疗后，3组患者脑脊液中白细胞数、蛋白含量、葡萄糖含量及颅内压水平均较治疗前有明显变化（P均〈0．01），但3组间比较差异均无统计学意义（P均〉0．05）。在治疗有效时间上，A组平均用时（12．80±2．25）d，B组（12．64±2．00）d，C组（9．44±1．50）d，差异有统计学意义（F=25．94，P〈0．05），对其进行两两分析发现，A、B组与C组比较差异均有统计学意义（t值分别为2．769、2．854，P均〈0．05）但A、B组间比较差异无统计学意义（t=0．119，P=0．908；）。A、B、C3组治疗有效例数分别为45例（占89．1％）、53例（占94．6％）、46例（占95．8％），其中A组死亡3例，B组死亡3例，C组2例死亡。经统计分析，3组治疗总有效率比较差异无统计学意义（P〉0．05）。而在细菌清除率上，A、C两组分别33例（占68．75％）、35例（占72．9l％），而B组仅为23例（占41．07％）A、C组明显优于B组（X2值分别为9．478、10．63，P均〈0．05）。结论腰大池置管外引流联用鞘内注射给药在脑脊液漏合并有颅内感染治疗中具有较高的临床应用价值，可有效缩短治疗有效时间，提高总体治疗效果。Objective To investigate the clinical effect of lumbar catheter drainage combined with intrathecal injection on patients with cerebrospinal fluid leakage and intraeranial infection. Methods A retrospective study was conducted. One hundred and fifty-two cases with cerebrospinal fluid leakage and intracranial infection were selected as our subjects who were hospitalized in the First Hospital of Yuncheng from 2006 to 2014. The patients were divided into lumbar puncture ＋ intrathecal group（ A）＇, lumbar （ group B） and lumbar intrathecal large pool ＋ group （group C） based on post-processing methods. A experimental data were recorded and compared in terms of the total efficiency of treatment, the therapeutically effective time, bacterial clearance and security differences. Results After treatment,the levels of white blood cells,protein, glucose and intracranial pressure were changed compared with that of before treatment in three group （P 〈 0. 01 ）, but there was no significant difference among the three groups （ P 〉 0.05 ）. The therapy periods in group A, group B and group C were （12. 80 ± 2. 25） d, （12.64 ± 2. 00） d and （9. 44± 1.50） d respectively and the difference was significant（F = 25.94,P 〈 0.05）. Compared with Group C, the therapy periods in group A and B were significant different（ t = 2. 769,2. 854 ;P 〈 0, 05）, but there was no significant difference between group A and B （t =0. 119,P =0. 908）. The cases with success effect was 45（89. 1% ） in group A,53（94. 6% ） in group B,46 （95.8%） in group C, and there was no significant difference among three groups （ P 〉 0. 05 ）. In terms of bacterial clearance rate, 33 cases （ 68.75 % ） was in group A, 35 cases （ 72. 91% ） in group C and 23 cases （41.07%） in group B and the effective rate in group A or C were higher than that in group B （X2 = 9. 478, 10. 63 ; P 〈 0.05）. Conclusion The methods of lumbar catheter drainage combined with intrathecal injection is proved with a hi

关 键 词：腰大池置外引流 鞘内给药 脑脊液漏 颅内感染 

分 类 号：R743.35[医药卫生—神经病学与精神病学]