开颅术后辅助腰大池持续引流治疗重型颅脑损伤_医学论文.docVIP

开颅术后辅助腰大池持续引流治疗重型颅脑损伤_医学论文 开颅术后辅助腰大池持续引流治疗重型颅脑损伤_医学论文 作者：吴志峰，何永垣，毛志钢 【摘要】 目的 探讨开颅术后辅助腰大池持续引流治疗重型颅脑损伤的机制和效果。方法 重型颅脑损伤开颅术后患者116例，随机分为治疗组和对照组。治疗组患者于开颅术后第2天行腰大池持续引流，对照组患者于开颅术后第2天行腰穿放液。结果 治疗组和对照组患者脑脊液中红细胞( RBC）＜100×106 / L的时间分别为伤后(5.0±2.3)天和(7.1±3.5)天(0. 0l)；两组脑脊液中蛋白 (TP）lt0.8g/L的时间分别为伤后(8.0±3.6)天和(11.2±4.4) 天(0.01)；治疗组伤后1周内平均颅内压、甘露醇用量显著低于对照组；脑积水及脑梗死发生率显著低于对照组；重残率、病死率显著低于对照组。结论 腰大池持续引流可快速廓清患者的血性脑脊液，辅助降低颅内压，减少甘露醇用量，减少并发症，显著降低重残率及病死率，改善预后。 【关键词】 重型颅脑损伤；血性脑脊液；颅内压；腰大池持续引流术 【Abstract】 Objective To discuss the mechanism and effect of treatment of drainage subarachnoid lumbar space continuously with severe craniocerebral trauma after craniotomy. Methods There were 116 cases of severe craniocerebral trauma postoperatively，we divided therapeutic group and contrast group randomly. We used continuous drainage subarachnoid lumbar space the next day postoperatively in therapeutic group，and in contrast group we used lumbar puncture at the same time.Results The postoperative amount of RBC less than 100×106 /L( RBC lt 100×106 / L )was (5.0d，2.3d) and (7.1d，3.5d) in therapeutic group and contrast group respectively(0.0l).The total protein in cerebrospinal fluid postoperative less than 0.8g/L(T0. 8g/ L)was(8.0±3.6d) and (11.2±4.4d) in therapeutic group and contrast group，respectively(0.0l).The average intracranial pressure，the usage and dose of mannitol，hydrocephalus，cerebral infarction，and fatality rate were statisticsly significance in treatment group and contrast group.Conclusion The method of continuous drainage subarachnoid lumbar space with severe craniocerebral trauma after craniotomy could cleaned bloody cerebrospinal fluid more quicker， decreasing intracranial pressure，decreasing the usage of mannitol，decreasing complication and fatality rate， improving prognosis. 【Key words】 severe craniocerebral trauma： bloody cerebrospinal fluid：intracranial pressure： drainage subarachnoid lumbar space 重型颅脑伤GCS 3～8分的死亡率在35%左右［1］。开颅血肿清除大骨瓣减压术及按Mashall降颅压措施［2］，颅内压仍然显著升高者，治疗上十分困难。重型颅脑损伤常