皮下隧道法腰池引流在动脉瘤性蛛网膜下腔出血后的临床研究

Clinical study of subcutaneous tunnel method of lumbar drainage in aneurysmal subarachnoid hemorrhage

目的:探讨皮下隧道法腰池引流在动脉瘤性蛛网膜下腔出血开颅术后的临床应用优点。方法:采用前瞻性随机对照的研究方法,收集2015年9月至2017年5月确诊为动脉瘤性蛛网膜下腔出血且开颅术后行腰池引流的患者共80例,随机分为研究组与对照组,每组各40例,比较其腰池引流相关的感染率与穿刺点渗漏率。结果:研究组穿刺点渗漏率为0.0%(0/40),对照组为12.5%(5/40),差异有统计学意义(P=0.021);而研究组腰池引流相关的感染发生率为7.5%(3/4 0),对照组为1 2.5%(5/4 0),差异无统计学意义(P=0.4 5 6),但研究组中感染率下降明显。结论:皮下隧道法腰池引流在动脉瘤性蛛网膜下腔出血开颅术后能显著减少穿刺点渗漏率,在预防腰池置管后继发的引流相关的感染方面有较大优势,值得在临床上推广。

Objective： To investigate the clinical application advantages of subcutaneous tunnel method for lumbar drainage in aneurysmal subarachnoid hemorrhage after craniotomy. Methods： In this prospective randomized control study, 80 aneurysmal subarachnoid hemorrhage after craniotomy form September 2015 to May 2017 were randomized to the study group of conventional therapy plus subcutaneous tunnel and the control group of conventional therapy alone. The study group and control group included 40 patients, respectively. The infection rate associated with lumbar drainage and puncture point leakage rate were evaluated. Results： Of the 40 patients in the study group, the leakage rate of puncture points was 0.0%（0/40）, which was significantly lower than the control group of 12.5%（5/40）, and the difference was statistically significant（P=0.021）. The incidence rate of lumbar drainagerelated infections were 7.5%（3/40） in the study group and 12.5%（5/40） in the control group, and the difference was not statistically significant（P=0.456）, but there was a decrease in infection rate. Conclusion： Subcutaneous tunnel lumbar drainage in the aneurysmal subarachnoid hemorrhage after craniotomy can significantly reduce the puncture point leakage, the advantage of prevention of secondary drainage-related infections after lumbar catheterization is great and is worth popularizing in clinical practice.