腰大池结合侧脑室持续灌洗引流治疗脑脊液漏并发颅内感染中的临床应用

Clinical Application of Continued Lumbar Cerebrospinal Fluid Drainage in Treatment of Cerebrospinal Fluid Leakage Complicated with Intracranial Infection

目的探讨腰大池结合侧脑室持续灌洗引流在重型颅脑损伤术后脑脊液漏并发颅内感染中的应用价值。方法将2014年1月-2016年6月某院收治的76例重型颅脑损伤术后脑脊液漏并发颅内感染患者随机分为观察组和对照组各38例。对照组患者给予腰大池抗生素鞘内灌洗结合持续引流治疗,观察组患者先行侧脑室抗生素灌洗引流,待颅压稳定后再常规给予腰大池抗生素灌洗结合持续引流治疗。观察并记录两组患者引流时间及感染控制时间,引流过程中颅内压及脑脊液成分指标的变化,同时对引流后临床疗效、并发症及出院后3个月的预后情况进行评价。结果观察组患者引流及感染控制时间均较对照组明显缩短,差异有统计学意义(P<0.01)。随着灌洗引流的进行,患者颅内压,脑脊液蛋白质、白细胞指标均呈降低趋势,而葡萄糖指标呈升高趋势,且观察组在引流1周及引流结束时各指标均明显优于对照组(除引流1周脑脊液葡萄糖指标),差异均有统计学意义(P<0.05或P<0.01)。观察组整体疗效较对照组明显改善,差异有统计学意义(P<0.05)。引流期间,两组患者均未发现颅内并发症。出院后3个月,观察组GOS评分明显高于对照组,差异有统计学意义(P<0.05)。结论对于重型颅脑损伤术后脑脊液漏并发颅内感染患者,早期行腰大池结合侧脑室持续灌洗引流能发挥二者各自的优势,弥补不足,不仅能在一定程度上提高临床疗效,缩短引流及感染控制时间,更好地改善颅内压,促进脑脊液成分恢复正常,而且有助于改善患者临床预后,值得临床推广。

Objective To investigate the value of CLCFD in the treatment of cerebrospinal fluid leakage complicated with intracranial infection after severe craniocerebral injury. Methods A total of 76 patients with severe cerebrospinal fluid leakage complicated with intracranial infection after operation from January, 2014 to June, 2016 were randomly divided into the observation group and the control group, each with 38 cases. Patients in the control group were treated with lumbar cistern lavage combined with continuous drainage. The patients in the observation group were treated with antibiotic lavage and drainage of the lateral ventricles, and then they were treated with antibiotics in the large pool and combined with continuous drainage when the intracranial pressure was stabilized.Observe and record the drainage time and infection control time of two groups of patients, changes of intracranial pressure and drainage of cerebrospinal fluid components, and the clinical curative effect of drainage, complications and prognosis of 3 months after discharge was evaluated. Results The drainage and infection control time of the observation group were significantly shorter than that of the control group, the difference was statistically significant（P〈0.01）. With the lavage and drainage, intracranial pressure, cerebrospinal fluid protein, white blood cell index showed a decreasing trend, while glucose index increased, and the observation group in 1 weeks of drainage and drainage at the end of each index were significantly better than the control group（except for 1 weeks of drainage of CSF glucose index）, the differences were statistically significant（P 0.05 or P〈0.01）. The overall curative effect of the observation group was significantly improved compared with the control group, the difference was statistically significant（P〈0.05）. No intracranial complications were found in the two groups during the drainage period. 3 months after discharge, the GOS score of the observation group was higher than that of the control group,the difference was statistically significant（P〈0.05）. Conclusion For the patients with cerebrospinal fluid leakage complicated with intracranial infection after severe traumatic brain injury, CLCFD can play their respective advantages, not only can improve the clinical curative effect to a certain extent, shorten the drainage time and infection control, to better improve the intracranial pressure, promote the recovery of normal cerebrospinal fluid composition, but also help improve the clinical prognosis, which is worthy of clinical application.