腰大池持续引流联合标准骨瓣减压治疗重型颅脑损伤的应用效果  

Application Effect of Continuous Lumbar Cistern Fluid Drainage Combined With Decompressive Craniectomy in the Treatment of Severe Craniocerebral Injury

作　　者：杜敬华[1] 刘国军[1] 王位坐 DU Jinghua;LIU Guojun;WANG Weizuo(Department of Neurosurgery,The Fourth Affiliated Hospital of China Medical University,Shenyang 110031,China)

机构地区：[1]中国医科大学附属第四医院神经外科,沈阳110031

出　　处：《四川大学学报（医学版）》2023年第5期1040-1045,共6页Journal of Sichuan University(Medical Sciences)

基　　金：辽宁省自然基金面上项目(No.2020-MS-147)资助。

摘　　要：目的分析腰大池持续引流联合标准骨瓣减压治疗重型颅脑损伤的应用效果。方法回顾性选取2016年3月–2021年3月本院收治重型颅脑损伤患者87例。根据减压方法将其分为两组,其中对照组42例,实施标准骨瓣减压;引流组45例,实施腰大池持续引流联合标准骨瓣减压。主要比较两组患者CT显影消失时间、住院时间、甘露醇用量、术后拔管时间,格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、预后情况、脑水肿和脑梗死发生率以及并发症;次要比较两组治疗前、持续引流7 d后的颅内压、脑脊液抗核体蛋白SP100以及红细胞数。结果引流组CT显影消失时间以及住院时间均短于对照组,甘露醇用量少于对照组,引流组脑水肿发生率、并发症发生率均低于对照组,且预后良好率高于对照组(P<0.05)。两组预后不良率与死亡率差异无统计学意义(P>0.05)。引流组术后拔管时间为(8.24±1.09)d,对照组术后拔管时间为(9.22±1.26)d,差异有统计学意义(t=3.887,P<0.05)。引流组脑梗死发生2例(4.44%),梗死体积为(8.36±1.87)cm^(3),对照组脑梗死发生9例(21.43%),梗死面积为(8.36±1.87)cm^(3),差异均有统计学意义(χ^(2)=5.674,t=9.609,P<0.05)。治疗后,两组颅内压和红细胞数量均降低,且引流组颅内压、脑脊液SP100以及红细胞数量低于对照组(P<0.05)。引流组脑脊液SP100治疗后较治疗前降低(P<0.05),对照组治疗前后差异无统计学意义。结论重型颅脑损伤术后患者实施腰大池持续引流能有效缩短机体康复所需时间,能显著降低颅内压水平,改善脑水肿与脑梗死水平,对于预后恢复具有较高的安全性。Objective To analyze the application effect of continuous lumbar cistern fluid drainage combined with decompressive craniectomy in the treatment of severe craniocerebral injury.Methods A total of 87 patients with severe craniocerebral injury admitted to our hospital between March 2016 and March 2021 were retrospectively enrolled.They were divided into two groups according to the decompression methods applied,with 42 patients who received standard decompressive craniectomy assigned to the control group and 45 patients who received continuous lumbar cistern fluid drainage combined with standard decompressive craniectomy assigned to the observation group.The primary indicators that were monitored and compared between the two group included the amount of time for patient CT imaging to be clear of subarachnoid hemorrhage,the length-of-stay,the duration of post-operative intubation,the mannitol dose,scores for Glasgow Coma Scale(GCS),prognosis,the incidence of cerebral edema and cerebral infarction,and complications.The secondary indicators that were monitored and compared included intracranial pressure,cerebrospinal fluid antinucleosome protein SP100,and red blood cell count of the two groups before treatment and after continuous drainage for 7 days.Results The amount of time for CT imaging to be clear of subarachnoid hemorrhage and the length-of-stay of the observation group were shorter than those of the control group,the mannitol dose of the observation group was lower than that of the control group,the incidence of cerebral edema and the incidence of complications of the observation group were lower than those of the control group,and the rate of patients with good prognosis in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the rate of poor prognosis or mortality between the two groups(P>0.05).The duration of postoperative intubation of the observation group was(8.24±1.09)d,while that of the control group was(9.22±1.26)d,and the difference between t

关 键 词：腰大池持续引流 标准骨瓣减压 重型颅脑损伤 脑水肿 脑梗死 

分 类 号：R651.15[医药卫生—外科学]