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目的探讨腰大池结合侧脑室持续灌洗引流在重型颅脑损伤术后脑脊液漏并发颅内感染中的应用价值。方法将2014年1月-2016年6月某院收治的76例重型颅脑损伤术后脑脊液漏并发颅内感染患者随机分为观察组和对照组各38例。对照组患者给予腰大池抗生素鞘内灌洗结合持续引流治疗,观察组患者先行侧脑室抗生素灌洗引流,待颅压稳定后再常规给予腰大池抗生素灌洗结合持续引流治疗。观察并记录两组患者引流时间及感染控制时间,引流过程中颅内压及脑脊液成分指标的变化,同时对引流后临床疗效、并发症及出院后3个月的预后情况进行评价。结果观察组患者引流及感染控制时间均较对照组明显缩短,差异有统计学意义(P<0.01)。随着灌洗引流的进行,患者颅内压,脑脊液蛋白质、白细胞指标均呈降低趋势,而葡萄糖指标呈升高趋势,且观察组在引流1周及引流结束时各指标均明显优于对照组(除引流1周脑脊液葡萄糖指标),差异均有统计学意义(P<0.05或P<0.01)。观察组整体疗效较对照组明显改善,差异有统计学意义(P<0.05)。引流期间,两组患者均未发现颅内并发症。出院后3个月,观察组GOS评分明显高于对照组,差异有统计学意义(P<0.05)。结论对于重型颅脑损伤术后脑脊液漏并发颅内感染患者,早期行腰大池结合侧脑室持续灌洗引流能发挥二者各自的优势,弥补不足,不仅能在一定程度上提高临床疗效,缩短引流及感染控制时间,更好地改善颅内压,促进脑脊液成分恢复正常,而且有助于改善患者临床预后,值得临床推广。
Objective To investigate the value of lumbar cistern combined with sustained lavage and drainage of lateral ventricle in patients with cerebrospinal fluid leakage and intracranial infection after severe craniocerebral injury. Methods Seventy-six patients with cerebrospinal fluid leakage and intracranial infection who were admitted to our hospital from January 2014 to June 2016 in our hospital were randomly divided into observation group (38 cases) and control group (38 cases). Patients in the control group were treated with intrathecal lavage combined with continuous drainage of antibiotics in lumbar cistern, and the patients in observation group were given lavage and drainage of antibiotics prior to intraventricular administration. After intracranial pressure stabilized, they were routinely given lavage antibiotics combined with continuous drainage treatment. The time of drainage and infection control, the intracranial pressure and the changes of cerebrospinal fluid (CSF) composition during the drainage were observed and recorded. The clinical efficacy, complications and the prognosis after 3 months of discharge were evaluated. Results The drainage and infection control time of patients in the observation group were significantly shorter than those in the control group (P <0.01). With lavage and drainage, the intracranial pressure, cerebrospinal fluid protein and leukocyte index decreased, while the glucose index showed an increasing trend. The observation group was significantly better than the control group at 1 week of drainage and at the end of drainage (Except 1 week after drainage of cerebrospinal fluid glucose), the differences were statistically significant (P <0.05 or P <0.01). The overall efficacy of the observation group was significantly improved compared with the control group, the difference was statistically significant (P <0.05). During drainage, no intracranial complications were found in either group. Three months after discharge, the GOS score of the observation group was significantly higher than that of the control group, with a significant difference (P <0.05). Conclusion For patients with cerebrospinal fluid leakage complicated with intracranial infection after severe craniocerebral injury, the combination of lumbar cistern and left ventricular sustained lavage drainage can exert their advantages and make up for the deficiency, which not only can improve the clinical curative effect and shorten the drainage And infection control time, to better improve intracranial pressure and promote normal CSF component, and help to improve the clinical prognosis of patients, it is worth clinical promotion.