间歇性流量控制脑室外引流术在婴幼儿急性脑积水中的降颅压作用

Application of external ventricular drainage with intermittent mode in acute hydrocephalus of infants and young children

目的观察间歇性流量控制外引流术在婴幼儿急性脑积水颅内感染期或脑室出血期中的降颅压作用。方法回顾性分析2017年1月至2019年6月在上海交通大学医学院附属上海儿童医学中心神经外科行侧脑室外引流术的急性脑积水患儿的临床资料,共43例。所有患儿均为颅内感染期或出血期有明显颅高压表现者。采取间歇性流量控制外引流方式,在患儿安静或睡眠时开放引流,每日引流总量控制在约100 ml。观察外引流术的疗效及相关的颅内出血、脑脊液漏及感染等并发症的发生率。结果 43例患儿共行47例次脑室穿刺外引流术,所有患儿颅高压症状均明显改善,脑室感染或脑室出血均治愈。置管的中位时间为14(5~60)d。外引流期间继发性脑室内出血2例(4.7%),脑脊液漏3例(7.0%),引流管堵塞2例(4.7%),无一例发生导管相关性继发感染。二期均行脑室-腹腔分流术。结论婴幼儿急性脑积水颅内感染期或脑室出血期采用间歇性流量控制外引流术能安全、有效地降低颅内压,降低脑出血和硬膜下积液的风险,不增加继发性感染的风险。

Objective To explore a convenient and effective way of external drainage for infants and young children with acute hydrocephalus.Methods A retrospective analysis was conducted on 43 children of acute hydrocephalus who underwent external drainage of the lateral ventricle at Department of Neurosurgery,Shanghai Children′s Medical Center,Shanghai Jiaotong University School of Medicine.All children demonstrated significant symptom of intracranial hypertension(IH)during infection or bleeding.Intermittent flow control mode was employed for external drainage,which was performed when the child was quiet or asleep.The total daily drainage was controlled at about 100 ml.The efficacy of external drainage and the incidence of related bleeding,cerebrospinal fluid(CSF)leakage and infection were observed.Results A total of 47 procedures of ventricular puncture and external drainage were performed in 43 cases.All children with IH symptoms were significantly improved,and their infection or bleeding were resolved.The median duration of the catheter maintenance was 14(5 to 60)d.During external drainage,there were 2 cases of secondary ventricular hemorrhage(4.7%),3 cases of CSF leakage(7.0%),2 cases of catheter blockage(4.7%),and none of them had catheter-related secondary infection.The second-stage ventricular-peritoneal shunting was performed in all cases.Conclusion External drainage with intermittent flow control mode during the period of intracranial infection period or ventricular hemorrhage in infants and young children with acute hydrocephalus can safely and effectively reduce intracranial pressure,reduce the risk of cerebral hemorrhage and subdural fluid accumulation,and does not seem to increase the risk of secondary infection.