内镜灌洗联合长程脑室外引流在感染性脑积水中的应用效果及患者预后影响因素分析

Application Effect of Endoscopic Lavage Combined with Long Tunnelled External Ventricular Drains in Patients with Infectious Hydrocephalus and Analysis of Prognostic Factors

目的探讨内镜灌洗(EL)联合长程脑室外引流(LTEVD)治疗感染性脑积水的效果,并分析患者预后影响因素。方法回顾性收集2016年1月至2021年12月在郑州大学第五附属医院接受LTEVD治疗的42例感染性脑积水患者的病例资料。依据是否联合EL治疗分为非EL(NEL)组(25例)与EL组(17例)。记录患者的一般情况、实验室指标以及影像学资料。术后3个月进行随访,对患者进行改良Rankin量表(mRS)评估和头颅平扫。将mRS≤3分定义为预后良好(29例),mRS>3分定义为预后不良(13例)。结果EL组与NEL组患者的性别、年龄、基础病史、实验室指标等因素相比,差异无统计学意义(P>0.05)。与NEL组相比,EL组患者术后mRS评分≤3分的人数较多,且Evans指数降低(P<0.05)。多因素logistic回归分析结果显示,脑脊液白细胞数>2000×10^(6) L^(-1)、术前格拉斯哥昏迷评分(GCS)<8分是感染性脑积水患者预后的独立危险因素(P<0.05)。结论在LTEVD的基础上联合EL能促进特定指征的感染性脑积水患者脑室体积恢复,影响患者预后的因素有脑脊液白细胞数与术前GCS评分。

Objective To explore the application effect of endoscopic lavage(EL)combined with long tunnelled external ventricular drains(LTEVD)in patients with infectious hydrocephalus and prognostic factors,and analyze the prognostic influencing factors of patients.Methods The case data of 42 patients with infectious hydrocephalus who received LTEVD treatment in the Fifth Affiliated Hospital of Zhengzhou University from January 2016 to December 2021 were retrospectively collected.The patients were divided into non-endoscopic lavage(NEL)group(25 cases)and EL group(17 cases)according to whether they were treated with EL.The general conditions,laboratory indicators and imaging data of the patients were recorded.Follow-up was carried out 3 months after the operation,and the patients were evaluated with the modified Rankin scale(mRS)and the head plain scan.mRS≤3 points were defined as good prognosis(29 cases)and mRS>3 points were defined as poor prognosis(13 cases).Results There was no statistical difference between EL group and NEL group in sex,age,basic medical history,laboratory indicators and other factors(P>0.05).Compared with NEL group,the number of patients with postoperative mRS score≤3 in EL group increased,and Evans index was lower(P<0.05).Multi-factor logistic regression analysis showed that the number of white blood cells in cerebrospinal fluid was more than 2000×10^(6) L^(-1) and preoperative Glasgow coma scale(GCS)<8 were independent risk factors affecting the prognosis of patients with infectious hydrocephalus(P<0.05).Conclusion Combined with EL on the basis of LTEVD can promote the recovery of ventricular volume in patients with infectious hydrocephalus with specific indications.The factors affecting the prognosis of patients are the number of white blood cells in cerebrospinal fluid and preoperative GCS score.