重度颅脑损伤术后脑脊液漏的手术处理方式及院内感染发生情况比较

Comparison of incidence of nosocomial infection after different operative treatments for cerebrospinal fluid leakage after operation of severe craniocerebral injury

目的探讨重度颅脑损伤术后脑脊液漏患者的手术处理方式以及内感染发生情况。方法收集2013年1月至2016年8月我院收治的90例重度颅脑损伤术后脑脊液漏患者,按照随机数字表法分为试验组及对照组各45例,分别实施腰大池持续脑脊液引流术及常规腰椎穿刺术,比较2组手术相关指标(手术时间、脑脊液漏停止时间、住院时间)、术前术后格拉斯哥昏迷评分(GCS)、治愈率、病死率及院内感染发生情况。结果 2组手术时间、病死率以及术前GCS评分差异无统计学意义(P>0.05);试验组脑脊液漏停止时间、住院时间短于对照组(P<0.05),两组术后GCS评分均较术前明显升高,且试验组评分高于对照组(P<0.05);术后试验组治愈率显著高于对照组,院内感染总发生率显著低于对照组(P<0.05)。结论腰大池持续脑脊液引流术可明显缩短重度颅脑损伤患者术后脑脊液漏停止时间及住院时间,有效改善患者预后效果并降低院内感染率,值得临床推广应用。

Objective To investigate the operative treatments for cerebrospinal fluid leakage after operation of severe craniocerebral injury and the incidence of nosocomial infection.Methods A total of 90 patients with cerebrospinal fluid leakage after operation of severe craniocerebral injury in our department from January 2013 to August 2016 were selected and randomly divided into experimental and control groups by random number table method,45 in each group.The two groups were treated with continued lumbar cerebrospinal fluid drainage and routine lumbar puncture,respectively.The operation related indicators such as operation time,stop time of cerebrospinal fluid leakage and hospitalization time,Glasgow coma scale（ GCS） scores,cure rate,mortality and incidence of nosocomial infection were compared between the two groups.Results There was no significant difference in operation time,mortality rate and preoperative GCS score between the two groups（ P〉0. 05）.The stop time of cerebrospinal fluid leakage and hospitalization time of the experimental group were significantly shorter than those of the control group（ P〈0. 05）.GCS scores of the two groups after operation were significantly higher than those before operation,and the score of experimental group was significantly higher than that of the control group after operation（ P〈0. 05）.The cure rate was significantly higher while the incidence of postoperative nosocomial infection of the experimental group was significantly lower than those of the control group（ P〈0. 05）. Conclusion Continued lumbar cerebrospinal fluid drainage can shorten the stop time of cerebrospinal fluid leakage and hospitalization time of the patients.It can effectively improve the prognosis and reduce the nosocomial infection rate.It is worthy of clinical application.