腰大池持续脑脊液引流术治疗老年重型颅脑损伤病人手术后脑脊液漏的疗效  

Effects of continuous lumbar cistera drainage on cerebrospinal fluid leakage in elderly patients with severe craniocerebral injury

作　　者：张志 唐志珍 ZHANG Zhi;TANG Zhi-zhen(Department of Neurosurgery,Beijing Aerospace General Hospital,Beijing 100076,China)

机构地区：[1]北京航天总医院神经外科,北京市100076

出　　处：《实用老年医学》2019年第3期249-252,共4页Practical Geriatrics

摘　　要：目的探讨腰大池持续脑脊液引流术对重型颅脑损伤手术后脑脊液漏病人的治疗效果。方法选取2014年2月至2016年3月我院收治的重型颅脑损伤手术后发生脑脊液漏的老年病人68例,依据随机数字表法分为观察组(腰大池持续脑脊液引流术)和对照组(常规引流术),每组34例,比较2组病人的治疗效果、预后和并发症。结果观察组病人的脑脊液漏停止时间、脑脊液压力恢复正常时间、脑脊液转清时间和住院时间均明显低于对照组,差异具有统计学意义(P<0. 05)。观察组预后良好27例,中、重残5例,植物生存1例,死亡1例;对照组预后良好20例,中、重残11例,植物生存1例,死亡2例。观察组并发脑积水1例,迟发性脑出血1例,颅内感染1例,癫痫1例,并发症总发生率为11. 76%;对照组脑积水4例,迟发性脑出血3例,颅内感染4例,癫痫3例,总发生率为41. 18%。结论腰大池持续脑脊液引流术治疗重型颅脑损伤手术后脑脊液漏老年病人疗效显著,能够有效改善脑脊液漏,优化老年病人预后,降低术后不良并发症发生风险。Objective To investigate the effect of continuous lumbar cisterna drainage for cerebrospinal fluid in the patients with cerebrospinal fluid leakage after severe craniocerebral injury surgery.Methods A total of 68 elderly patients with cerebrospinal fluid leakage after severe craniocerebral injury treated in our hospital from February 2014 to March 2016 were selected.According to the random number table method,the patients were divided into the observation group and the control group,with 34 cases in each gorup.The observation group received continuous lumbar cisterna drainage,and the control group received conventional drainage.The treatment effect,prognosis and adverse complications of the two groups were compared.Results The cerebrospinal fluid leakage stop time,recovery time of cerebrospinal fluid pressure,cerebrospinal fluid transfer time and hospitalization time were significantly lower in the observation group than those in the control group(P<0.05).In the observation group,27 cases presented with a good prognosis,5 cases with moderate and severe disability,1 case with plant survival,and 1 case dying,compared with 20,11,1,2 cases in the control group.In the observation group,there was 1 case of hydrocephalus,1 case of delayed cerebral hemorrhage,1 case of intracranial infection,1 case of epilepsy,with a total incidence of complication of 11.76%.In the control group,there was 4 cases of hydrocephalus,3 cases of late cerebral hemorrhage,4 cases of intracranial infection and 3 cases of epilepsy,with a total incidence of complication of 41.18%.Conclusions Longitudinal continuous lumbar cisterna drainage in the treatment of severe craniocerebral injury in the elderly patients with cerebrospinal fluid after surgery shows good effects.It can effectively improve cerebrospinal fluid leakage,optimize the prognosis of the elderly patients,and reduce the risk of postoperative adverse complications.

关 键 词：腰大池持续脑脊液引流术 重型颅脑损伤 脑脊液漏 

分 类 号：R651[医药卫生—外科学]