腰大池持续引流术对老年重型颅脑损伤患者颅内压和并发症及预后的影响

目的:探讨腰大池持续引流术对老年重型颅脑损伤患者颅内压、并发症和预后的影响。方法:选取2014年8月～2018年8月期间成都医学院第一附属医院收治的老年重型颅脑损伤患者60例为研究对象。根据随机数字表法将患者分为对照组(n=30)与研究组(n=30),其中对照组术后给予常规的脱水对症治疗,研究组则在此基础上给予腰大池持续引流术。比较两组术后临床疗效以及并发症,术后3d、5d、7d颅内压,随访半年,观察两组患者预后。结果:研究组治疗后总有效率为90.00%,显著高于对照组患者的66.67%(P0.05)。两组患者术后3d、5d、7d颅内压均较术前降低,且研究组低于对照组(P0.05)。研究组脑梗死、脑水肿、硬膜下积液、癫痫、纵裂积液等并发症发生率均低于对照组(P0.05),而颅内感染比较差异无统计学意义(P0.05)。研究组良好例数高于对照组,而重残以及死亡例数均低于对照组,差异有统计学意义(P0.05);而两组轻残、植物生存例数比较差异无统计学意义(P0.05)。结论:腰大池持续引流术治疗老年重型颅脑损伤患者,疗效满意,可显著改善患者颅内压,减少并发症发生率,改善患者预后,适于临床推广。

Effect of Continuous Lumbar Cistern Drainage on Intracranial Pressure, Complications and Prognosis in Elderly Patients with Severe Craniocerebral Injury

ABSTRACT Objective: To investigate the effect of continuous lumbar cistern drainage on intracranial pressure, complications and prognosis in elderly patients with severe craniocerebral injury. Methods: 60 elderly patients with severe craniocerebral injury admitted in First Affiliated Hospital of Chengdu Medical College from August 2014 to August 2018 were selected as the study subjects. The patients were divided into control group (n=30) and research group (n=30) according to random number table method. The control group was given routine dehydration symptomatic treatment after operation, and the research group was given continuous lumbar cistern drainage on this basis. The clinical efficacy and complications were compared between the two groups, and Intracranial pressure at 3d, 5d and 7d after operation. Follow-up for half a year to observe the prognosis of two groups of patients. Results: The total effective rate of the study group was 90.00% after treatment, which was significantly higher than that 66.67% of the control group(P<0.05). The intracranial pressure of the two groups decreased 3d, 5d and 7d after operation and the study group was lower than control group (P<0.05). The incidence of cerebral infarction, cerebral edema, subdural effusion, epilepsy and longitudinal fissure effusion in the study group was lower than that in the control group(P<0.05), but there was no significant difference in intracranial infection (P>0.05). The number of good cases in the study group was higher than that in the control group, while the number of severe disabilities and deaths in the study group was lower than that in the control group (P<0.05), but there was no significant difference in the number of mild disabilities and plant survival between the two groups (P>0.05). Conclusion: Continuous lumbar cistern drainage is effective in the treatment of elderly patients with severe craniocerebral injury. It can significantly improve the intracranial pressure, reduce the incidence of complications and improve the prognosis of patients. It is suitable for clinical promotion.