持续腰大池引流脑脊液加鞘内注入地塞米松治疗重型颅脑损伤的研究

Research on combined continuous lumbar subarachnoid drainage with dexamethasone intrathecal injection in the treatment of craniocerebral trauma after craniotomy

目的探讨腰大池持续引流脑脊液加鞘内注入地塞米松治疗重度颅脑损伤的临床疗效。方法对于GCS评分3-6分的重型颅脑损伤的88例病人,随机分为实验组和对照组。常规抗炎、脱水、止血、对症或手术治疗,并在入院或开颅后行ICP、CPP监护;实验组加做持续腰大池引流脑脊液术并鞘内注入地塞米松：5mg＋NS10ml每日2次。结果实验组颅内压下降明显,并发症少,良好38.6%,中残31.8%,重残11.4%,植物生存9.1%,死亡9.1%。结论持续腰大池引流脑脊液加鞘内注入地塞米松治疗重型颅脑损伤,有效地减轻脑水肿,降低颅内压,减少并发症,提高抢救的成功率和改善患者的生存质量。

Objective To evaluate the efficacy of combined continuous lumbar subarachnoid drainage with dexamethasone intrathecal injection in the treatment of craniocerebral trauma after craniotomy. Methods 88 patients with craniocerebral trauma （GCS 4-6） were divided into two groups randomly, in control group, the patients received anti-inflammation, hemostasis, dehydration therapy or surgery in experimental group, combined continuous lumbar subarachnoid drainage with dexamethasone intrathecal injection （dexamethasone 5mg＋NS10ml twice a day ） was performed in addition to routine therapy. Resuits The intracranial pressure and complications decreased significantly in expertmental group, tne good recovery rate, the moderate deficit rate, the severe deficit rate,the persistent vegetative status rate and the death rate were 38.6 % ,31.8 %, 11.4 % and 9.1%, respectively. Conclusions Combined continuous lumbar subarachnoid drainage with dexamethasone intrathecal injection is effective in the treatment of craniocerebral trauma it can decrease intracranial pressure and complications and improve the successful rescue rate and patients＇ quality of life.