床旁Ommaya储液囊植入术在早产儿脑积水治疗中的可行性分析

Feasibility analysis of bedside Ommaya reservoir implantation in the treatment of hydrocephalus in premature infants

目的探讨在新生儿重症监护室(NICU)对脑积水早产儿进行床旁Ommaya储液囊植入术与在手术室进行Ommaya储液囊植入术的差异,并探讨NICU床旁Ommaya储液囊植入术在早产儿脑积水治疗中的有效性和安全性。方法选取2021年1月至2022年12月在解放军总医院第七医学中心NICU住院明确诊断为脑积水且接受Ommaya储液囊植入术的68例早产儿作为研究对象。将2021年1—12月由NICU转入手术室进行手术的35例早产儿作为手术室组,2022年1—12月开展NICU床旁手术的33例早产儿作为NICU组。回顾性分析两组患儿的一般资料和术后转归情况。一般资料包括性别、出生体重、手术时体重、出生胎龄、手术时胎龄;术后转归包括术前和术中使用呼吸机比例,术后低体温、术后感染、术后相关并发症发生率,术后撤机时间、住院天数。结果两组患儿的性别、出生体重、手术时体重、出生胎龄、手术胎龄比较,差异均无统计学意义(P>0.05)。两组患儿术前使用呼吸机比例、术后感染发生率及术后相关并发症发生率比较,差异均无统计学意义(P>0.05)。NICU组术中使用呼吸机比例、术后低体温发生率、术后撤机时间、住院天数均显著低于或短于手术室组,差异有统计学意义(P<0.05)。结论NICU床旁Ommaya储液囊植入术可降低早产儿手术后低体温发生率以及术中使用呼吸机比例,缩短术后撤机时间、住院天数,且不会增加术后感染发生率,具备一定的临床可行性。

Objective To investigate the differences between bedside Ommaya reservoir implantation in the neonatal intensive care unit(NICU)and in the operating room,and investigate the efficacy and safety of NICU bedside Ommaya fluid reservoir implantation in the treatment of hydrocephalus in premature infants.Method A total of 68 premature infants diagnosed with hydrocephalus who admitted to our hospital from January 2021 to December 2022 and underwent Ommaya reservoir implantation were selected as the study objects.The patients who were transferred to the operating room for surgery were classified as the operating room group in 35 cases,and the patients who underwent bedside surgery were classified as the NICU group in 33 cases.The general data and postoperative outcomes of the two groups were analyzed retrospectively.General data included sex,birth weight,surgical weight,gestational age at birth,and gestational age at surgery.Postoperative outcomes included the proportion of ventilator use before and during surgery,incidence of postoperative hypothermia,postoperative infection,postoperative related complications,postoperative withdrawal time,and length of hospital stay.Result There were no significant differences in gender,birth weight,surgical weight,birth gestational age and surgical gestational age between the two groups(P>0.05).There was no significant difference in the proportion of children using ventilator before surgery,the incidence of postoperative infection and the incidence of postoperative complications between the two groups(P>0.05).The proportion of ventilator use,incidence of postoperative hypothermia,postoperative withdrawal time and hospitalization days in NICU group were significantly lower or shorter than those in the operating room group,with statistical significance(P<0.05).Conclusion Ommaya reservoir implantation near NICU bed can reduce the incidence of postoperative hypothermia and the proportion of ventilator use in premature infants,shorten the postoperative withdrawal time and hospitalization days,and does not increase the incidence of postoperative infection,which has certain clinical feasibility.