凝血酶浓度对纤维蛋白胶预防术后脑脊液漏的影响

Effect of thrombin concentration on the prevention of postoperative cerebrospinal leakage by fibrin glue

背景:纤维蛋白胶常用于预防硬脊膜损伤术后脑脊液漏,但标准浓度凝血酶纤维蛋白胶凝固过快致粘接硬脊膜效果差,低浓度凝血酶纤维蛋白胶封堵硬膜损伤预防脑脊液漏的效果尚不明确。目的:比较低浓度凝血酶及标准凝血酶浓度对纤维蛋白胶预防硬脊膜损伤术后脑脊液漏的效果。方法:选择2017年5月至2019年12月成都市第五人民医院收治的40例硬脊膜损伤患者,其中男25例,女15例,随机分2组进行治疗,每组20例:低浓度凝血酶组采用低浓度凝血酶(100IU/mL)封堵硬脊膜损伤,标准浓度凝血酶组采用标准浓度凝血酶(500IU/mL)封堵硬脊膜损伤。术后随访2个月,比较两组间脑脊液漏发生率、累计引流量、引流持续时间、切口并发症发生率等。试验获得成都市第五人民医院伦理委员会批准。结果与结论:①低浓度凝血酶组脑脊液漏发生例数、累计引流量、持续引流时间均少于标准浓度凝血酶组(P<0.05);②低浓度凝血酶组发生切口并发症1例、二次手术引流1例,标准浓度凝血酶组发生切口并发症2例、二次手术引流2例,两组间切口并发症与二次引流量比较差异无显著性意义(P>0.05);③结果表明,低浓度凝血酶纤维蛋白胶能降低脑脊液漏发生率、减少引流量、缩短引流时间,是封堵硬脊膜损伤的可靠方法。

BACKGROUND:Fibrin glue is commonly used to prevent postoperative cerebrospinal fluid leakage from dural injuries.However,fibrin glue with standardconcentration thrombin coagulates too fast,resulting in poor adhesion of dural mater.Effect of low-concentration thrombin fibrin glue on sealing dural injuries to prevent cerebrospinal fluid leakage is unclear.OBJECTIVE:To compare the effect of low-concentration thrombin and standard-concentration thrombin on the prevention of cerebrospinal fluid leakage from dural injuries by fibrin glue.METHODS:Forty patients including 25 males and 15 females with dural injuries admitted at Fifth People’s Hospital of Chengdu from May 2017 to December 2019 were enrolled.Patients were randomly divided into two groups,20 patients in each group.In low-concentration thrombin group,dural injuries were sealed with fibrin glue prepared with low-concentration thrombin solution(100 IU/mL).In standard-concentration thrombin group,dural injuries were sealed with fibrin glue prepared with standard-concentration thrombin solution(500 IU/mL).All patients were followed up for 2 months.The incidence of cerebrospinal fluid leakage,cumulative drainage flow,drainage duration and incision complications were compared between the two groups.The study was approved by Ethics Committee of Fifth People’s Hospital of Chengdu.RESULTS AND CONCLUSION:(1)The incidence of cerebrospinal leakage,accumulative volume and duration of drainage in the low-concentration thrombin group were lower than those of standard-concentration thrombin group(P<0.05).(2)Incision complications occurred in one case and secondary surgical drainage occurred in one case in the low-concentration thrombin group.Incision complications occurred in two cases and secondary surgical drainage occurred in two cases in the standard-concentration thrombin group.The incision complications and secondary surgical drainage were not statistically significant between the two groups(P>0.05).(3)These results indicate that fibrin glue prepared with low-concentration thrombin solution decreases the rate of cerebrospinal leakage,reduces the drainage volume and shortens the duration of drainage,which is demonstrated to be an effective strategy for sealing dural injuries.