重型颅脑损伤继发脑积水的引流治疗观察

Observation on drainage treatment of hydrocephalus secondary to severe craniocerebral injury

目的探讨重型颅脑损伤患者继发脑积水的引流治疗方法及效果。方法 68例重型颅脑损伤患者作为研究对象,均采用开颅血肿清除去骨瓣减压术进行治疗,根据术后治疗方案不同分为对照组和观察组,每组34例。对照组患者采用常规治疗,观察组患者在对照组基础上采用腰大池持续引流治疗。观察两组患者3个月内继发脑积水的发生情况,并作比较。对于两组出现继发脑积水患者采用脑室-腹腔分流术治疗后随访1年,观察患者的生存情况。结果观察组患者的继发脑积水发生率为5.88%(2/34),显著低于对照组的23.53%(8/34),差异具有统计学意义(P<0.05)。10例出现继发脑积水患者采用脑室-腹腔分流术引流治疗后,术后随访1年显示, 4例(40.00%)患者恢复良好, 3例(30.00%)患者轻残, 2例(20.00%)患者重残, 1例(10.00%)患者死亡。结论重型颅脑损伤患者于开颅血肿清除去骨瓣减压术后采用腰大池持续引流,有助于减少继发脑积水的发生率,对于出现继发脑积水患者采用脑室-腹腔分流术进行引流治疗能够起到较为理想的效果。

Objective To discuss the drainage method and effect of hydrocephalus secondary to severe craniocerebral injury. Methods A total of 68 severe craniocerebral injury patients as study subjects all undergoing debridement and decompression of craniotomy hematoma, and they were divided into control group and observation group by different treatment regimens after operation, with 34 cases in each group. The control group received conventional therapy, and the observation group received continuous drainage of lumbar cistern. The occurrence of secondary hydrocephalus in the two groups within 3 months was observed and compared. Secondary hydrocephalus patients in the two groups were followed up for 1 year after treatment of ventricular-peritoneal shunt to observe the survival of the patients. Results The incidence of secondary hydrocephalus was 5.88%(2/34) in the observation group, which was significantly lower than 23.53%(8/34) in the control group, and the difference was statistically significant(P<0.05). 10 patients with secondary hydrocephalus were treated by ventricular-peritoneal shunt. After 1 year follow-up, 4 patients(40.00%) recovered well, 3 patients(30.00%) were slightly disabled, 2 patients(20.00%) were severely disabled and 1 patient(10.00%) died. Conclusion The continuous drainage of lumbar cistern is helpful to reduce the incidence of secondary hydrocephalus in patients with severe craniocerebral injury after the removal of craniotomy hematoma and decompression of bone flap. The drainage treatment of ventricular-peritoneal shunt for patients with secondary hydrocephalus can play an ideal effect.