胸椎退行性病变减压术后脑脊液漏危险因素分析及护理研究

Risk factors analysis and nursing measures of cerebrospinal fluid leakage after thoracic decompression surgeries on degenerative thoracic disease

目的总结胸椎退行性病变减压术后脑脊液漏发生情况,并分析其危险因素,评估专科护理措施的干预效果。方法回顾性纳入2010年1月-2016年10月因胸椎退行性病变于我院行减压手术的162例次患者。收集其术后脑脊液漏的发生情况,同时记录其相应的术前诊断、并发症、手术方式、术中情况、术后低颅压头痛、切口愈合不良、椎间隙深部感染等并发症的相关资料。分别采用单因素及Logistic多因素回归分析脑脊液漏发生的危险因素。结果共有36例患者出现术后脑脊液漏,发生率为22.2%。不同的手术减压方式其术后脑脊液漏的发生率不同,其中,前方环形减压的术后脑脊液漏发生率最高。尽管很多临床因素均与脑脊液漏的发生率相关,但Logistic回归分析提示:年龄大于52岁、减压节段大于3个、后纵韧带骨化症患者是其主要危险因素。8例出现低颅压综合征症状,无硬脊膜假性囊肿、切口部位感染及深部感染出现。结论退行性胸椎疾病减压术后脑脊液漏发生率较高,有效的临床及专科护理干预,是取得较好效果的保障。

Objective To describe the incidence of cerebrospinal fluid leakage （CSFL） after thoracic decompres- sion, analyze the risk factors and evaluate the effect of specialized nursing measures. Methods 162 patients with de- generative thoracic disease treated by thoracic decompression from January 2005 to October 2016 was examined in- trospectively. The medical records were reviewed and the occurrence of CSFL and the related clinical parameters were noted. The incidence of CSFL for the entire cohort and each surgical approach were described. The relationship be- tween CSFL and other clinical parameters were evaluated,of which odds ratio and 95 %Cis of all CSFL--associated factors were calculated using multivariate logistic regression analysis. Results The total incidence of CSFL was 22. 2%. Different surgical approaches had different incidences of CSFL,and circumferential decompression had the high- est incidence. Though many different clinical parameters were related to the occurrences of CSFL, being older than 52 years, having ossification of the posterior longitudinal ligament or having longer operative segments than 3 vertebrae were significant risk factors for CSFL. No cases with the dural pseudocyst, surgical site infection and deep infection were found. 8 patients had low intracranial pressure syndrome symptoms. Conclusion The incidence of CSFL was higher after thoracic decompression. Effective clinical and specialist nursing intervention can achieve good results.