集束化管理在继发性脑积水治疗中的应用价值分析  

Cluster management in secondary hydrocephalus

作　　者：刘俊[1] 黄贤键[1] 高杰[1] 沙小松 张杰华 朱栋梁 吴楚伟 苏高健 Liu Jun;Huang Xianjian;Gao Jie;Sha Xiaosong;Zhang Jiehua;Zhu Dongliang;Wu Chuwei;Su Gaojian(Department of Neurosurgery,First Affiliated Hospital of Shenzhen University,Shenzhen Second People's Hospital,Shenzhen 518035,China)

机构地区：[1]深圳市第二人民医院、深圳大学第一附属医院神经外科,深圳518035

出　　处：《中华神经医学杂志》2023年第5期507-512,共6页Chinese Journal of Neuromedicine

基　　金：深圳市科技计划项目(JCYJ20180228163034627);深圳市卫生和计划生育委员会学科建设能力提升项目(SZXJ2018057);深圳市第二人民医院2022年院级临床研究项目(20223357035)。

摘　　要：目的探讨集束化管理在继发性脑积水治疗中的应用价值。方法选择深圳市第二人民医院神经外科自2016年1月至2021年6月采用脑室腹腔分流术治疗的77例继发性脑积水患者,根据管理方法的不同将患者分为传统管理组(30例)和集束化管理组(47例)。传统管理组患者术前行颅脑CT和连续3次以上腰穿脑脊液检测,结果均正常后行脑室腹腔分流术。集束化管理组患者术前除行颅脑CT和连续3次以上腰穿脑脊液检测外,加行集束化管理措施(包括术前颅脑MRI平扫及增强扫描、脑脊液DNA宏基因组检测、术中穿刺脑室后快速检测脑脊液并置入脑室镜探查脑室内情况等),确认无感染后行脑室腹腔分流术。比较2组患者术后半年分流失败率的差异及4种检查方法检测集束化管理组患者颅内感染阳性率的差异。结果与传统管理组比较,集束化管理组患者的分流失败率降低(20.0%vs.2.1%),差异有统计学意义(P<0.05)。脑室镜探查、脑脊液DNA宏基因组检测所示颅内感染阳性率(68.1%、61.7%)高于术前颅脑MRI平扫及增强扫描、脑脊液检测所示(14.9%、6.4%),差异有统计学意义(P<0.05)。结论集束化管理措施可有效降低继发性脑积水患者的分流失败率,其中脑脊液DNA宏基因组检测和脑室镜探查检测颅内感染的效能较高。Objective To explore the clinical value of cluster management in secondary hydrocephalus.Methods Seventy-seven patients with secondary hydrocephalus admitted to Department of Neurosurgery,Shenzhen Second People's Hospital from January 2016 to June 2021 were chosen;they were divided into traditional management group(n=30)and cluster management group(n=47)according to different management methods.Patients in traditional management group accepted craniocerebral CT and 3 consecutive times of cerebrospinal fluid tests,and normal results were achieved and then ventriculoperitoneal shunt(VPS)was performed.In patients from the cluster management group,on the basis of management treatment,cranial plain and enhanced MRI and DNA metagenomic next generation sequencing of cerebrospinal fluid were performed before surgery,and rapid test of cerebrospinal fluid and ventriculoscope observation were performed during surgery;after exclusion of intracranial infection,VPS was performed.The differences of shunt failure rate were compared between the two groups and the positive rates of intracranial infection detected by above 4 methods were compared in the cluster management group.Results There was significant difference in shunt failure rate between the cluster management group and traditional management group(2.1%vs.20.0%,P<0.05).The positive rates of intracranial infection by DNA metagenomics(61.7%)and ventriculoscopy(68.1%)were significantly higher than those by preoperative cranial plain and enhanced MRI(14.9%)and rapid test of cerebrospinal fluid(6.4%,P<0.05).Conclusion Cluster management can effectively decrease the VPS failure rate in secondary hydrocephalus;DNA metagenomics and ventriculoscopy have high efficiency in detecting intracranial infection.

关 键 词：继发性脑积水 脑室腹腔分流术 集束化管理 DNA宏基因组检测 脑室镜探查 

分 类 号：R651.1[医药卫生—外科学]