同轴支撑法中心静脉导管腰大池持续引流技术在神经重症患者中的应用分析  

Analysis on the application of coaxial support for central venous duct by continuous lumbar cistern drainage technique in the patients with severe neurological diseases

作　　者：方锦才[1] 安海龙[1] 仲晓军[1] 

机构地区：[1]武警浙江省总队医院神经外科,浙江嘉兴314000

出　　处：《中国现代医生》2018年第6期78-81,85,共5页China Modern Doctor

基　　金：浙江省嘉兴市科技计划项目(2017BY18048)

摘　　要：目的观察同轴支撑法中心静脉导管腰大池持续引流技术在神经重症患者中的临床效果。方法将我院重症加强护理病房收治的114例神经重症患者作为研究对象,按随机数字表法分为对照组及观察组各57例。对照组采用硬膜外导管引流,观察组采用同轴支撑法中心静脉导管腰大池持续引流技术。记录两组患者导管留置时间、血性脑脊液清除时间、脑脊液日均引流量等疗效指标,对术后患者是否出现神经根刺激症状、导管引流不畅、导管脱落情况以及感染情况等并发症进行监控记录,评价术后患者神经功能恢复情况。结果两组腰大池持续引流效果比较,观察组导管留置时间、血性脑脊液清除时间显著短于对照组,差异具有显著统计学意义(P<0.05)。两组脑脊液日均引流量并无统计学差异(P>0.05),但观察组脑脊液日均引流量波动幅度远低于对照组。两组持续腰大池引流置管的并发症中,观察组导管引流不畅(15.8%)、神经根刺激(10.5%)、感染(1.8%)及导管滑脱(5.3%)的发生率显著低于采用传统持续腰大池引流术的对照组,差异具有统计学意义(P<0.05)。观察组治疗有效率为82.46%,高于对照组治疗有效率为63.16%,差异具有统计学意义(P<0.05)。结论同轴支撑法中心静脉导管腰大池持续引流技术不但操作简便、成功率高、早期堵管概率小、引流安全、并发症少,而且材料便宜,利于推广应用。Objective To observe the clinical effect of coaxial support for central venous duct by continuous lumbar cistern drainage technique in the patients with severe neurological diseases. Methods 114 patients with severe neuro- logical diseases who were admitted to ICU in our hospital were selected as the study subjects. According to the method of random number table, the patients were divided into control group and observation group, with 57 cases in each group. The control group was given epidural catheter drainage, and the observation group was given coaxial support for central venous duct by continuous lumbar cistern drainage technique. The catheter indwelling time, bloody cere- brospinal fluid clearance time, daily average volume of cerebrospinal fluid drainage and other indicators of efficacy were recorded in both groups. Whether the patients had complications such as nerve root irritation symptoms, poor drainage of catheters, catheter falling off and infections were monitored and recorded after the surgery, and the recovery of neurological functions was evaluated in the patients after the surgery. Results The effect of continuous lumbar cistern drainage was compared between the two groups and the catheter indwelling time and bloody cerebrospinal fluid clear- ance time in the observation group were significantly shorter than those in the control group, and the differences were statistically significant（P〈0.05）. There was no statistically significant difference in daily average drainage volume of cerebrospinal fluid between two groups（P〉0.05）. However, the fluctuations of daily average volume of cerebrospinal fluid in observation group were much lower than that in the control group. For the complications induced by continuous lum- bar cistern drainage and indwelling in both groups, the incidence rate of poor catheter drainage（15.8%）, nerve root irri- tation（10.5%）, infection rate（1.8%） and catheter falling off（5.3%） in the observation group was significantly lower than that in the cont

关 键 词：腰大池引流 脑脊液 同轴支撑法 中心静脉导管 

分 类 号：R651.1[医药卫生—外科学]