腰椎穿刺蛛网膜下腔引流联合静脉滴注甘露醇在颅脑肿瘤手术的疗效观察  

Clinical Effect Observation of Lumbar Puncture Subarachnoid Drainage Combined with Intravenous Administration of Mannitol in Craniocerebral Tumor Surgery

作　　者：江竟成[1] 易勇[1] 张超[1] 屈小琴 向玉 Jiang Jingcheng;Yi Yong;Zhang Chao(Department of Neurosurgery,Department of CT/MR,Department of Anesthesiology,Yibin Second People's Hospital,West China Hospital Yibin Branch of Sichuan University,Yibin,Sichuan 644000,China)

机构地区：[1]宜宾市第二人民医院·四川大学华西医院宜宾医院神经外科,CT/MR科,麻醉科,四川宜宾644000

出　　处：《四川医学》2021年第8期820-823,共4页Sichuan Medical Journal

基　　金：宜宾市卫健委科研项目(编号:2019YW020)。

摘　　要：目的探讨颅脑肿瘤患者术中快速静脉滴注甘露醇后间断开放腰大池引流管释放脑脊液降低颅压对颅脑肿瘤手术的影响和术后并发症的临床意义。方法前瞻性选取我院2018年10月至2020年10月收治的颅脑肿瘤患者266例,随机分为观察组和对照组。观察组在全麻后腰椎穿刺蛛网膜下腔置管,置管前20 min快速静脉滴注甘露醇,打开颅骨后通过腰大池释放脑脊液降低颅压;对照组采用传统方式开颅手术。分析两组术中及术后情况。结果观察组手术时间(300±105)min、术后住院天数(16.7±6.0)d短于对照组手术时间(352±95)min、术后住院天数(19.4±12.1)d,观察组肺部感染(13.64%)、术后皮下积液(9.10%)、颅内感染发生率(7.57%)低于对照组肺部感染(2.24%)、术后皮下积液(1.5%)、颅内感染发生率(0.74%),差异有统计学意义(P<0.05)。结论通过腰椎穿刺蛛网膜下腔间断引流联合静脉滴注甘露醇,可明显缩短手术时间,减少术后皮下积液、肺部感染发生率及颅内感染发生率,减少术后住院天数,且简单安全易行,值得临床推广。Objective To explore the effect of intraoperative rapid infusion of mannitol on patients with brain tumors and the intermittent opening of the lumbar cistern drainage tube to release cerebrospinal fluid(CSF)to reduce intracranial pressure and the clinical significance of postoperative complications.Methods 266 cases of brain tumor patients in our hospital from October 2018 to October 2020 were selected and randomly divided into observation group and control group.In the observation group,after general anesthesia,lumbar puncture and subarachnoid catheterization were performed.Mannitol was infused intravenously 20 minutes before catheterization.After opening the skull,cerebrospinal fluid was released through lumbar cistern to reduce intracranial pressure;the control group was treated with traditional craniotomy.The intraoperative and postoperative conditions of the two groups were analyzed.Results the operation time(300±105)min,postoperative hospital stay(16.7±6.0)days of the observation group were shorter than those of the control group(352±95)min,(19.4±12.1)days,respectively.The incidence of pulmonary infection(13.64%),postoperative subcutaneous effusion(9.10%),intracranial infection(7.57%)in the observation group was lower than those in the control group(2.24%,1.5%,0.74%,respectively),the difference was statistically significant(P<0.05).Conclusion Through lumbar puncture subarachnoid intermittent drainage combined with intravenous administration of mannitol can significantly shorten the operation time,reduce the incidence of postoperative subcutaneous effusion,pulmonary infection and intracranial infection,reduce the postoperative hospital stay.It is simple,safe and feasible,and recommended for clinical application.

关 键 词：腰椎穿刺 蛛网膜下腔引流 甘露醇 手术时间 皮下积液 肺部感染 

分 类 号：R619[医药卫生—外科学]