摘要
目的对侧脑室引流管在结核性脑膜炎脑积水治疗中放置时间及拔管时机进行评估,观察临床转归。方法选择符合条件的结核性脑膜炎中、重度脑积水患者226例,分为改良脑室引流组(治疗组)127例和常规脑室引流组(对照组)99例,全部病例均行规范的全身抗结核、脱水及激素治疗。治疗组患者在局麻下改良脑室外引流,对照组按常规侧脑室额角穿刺外引流。两组患者均于术后第2天行脑室注射抗结核药物,引流两周后行24h夹闭导管试验,按拔管指征评估拔管可能性,进行疗效判定。结果治疗组127例中,引流时间窗符合拔管指征者76例,提前拔管19例,延迟拔管32例,导管放置时间(27.6±17.3)d,3例继发颅内感染,总有效率为74.8%(95/127),颅内感染发生率2.3%;对照组99例中,引流时间窗符合拔管指征者56例,提前拔管29例,延迟拔管14例,导管放置时间(18.9±15.2)d,7例继发颅内感染,总有效率为69.7%(69/99),颅内感染发生率7.1%。两组疗效对比差异无统计学意义(χ2=3.75,P>0.05),两组脑室外引流导管放置时间比较差异有统计学意义(t=2.413,P<0.05),两组颅内感染发生率比较差异有统计学意义(χ2=4.92,P<0.05)。结论结核性脑膜炎合并中、重度脑积水患者应早期行侧脑室外引流,配合脑室内注射药物治疗,效果显著,可使部分患者避免V-P分流手术。改良脑室外引流能降低颅内感染的发生率。妥善评估侧脑室引流管在结核性脑膜炎脑积水治疗中放置时间及拔管时机是取得良好预后的关键。
Objective To observe the retention time and the time of extubation of ventricular drainage tube which used to treat tuberculous meningitis with hydrocephalus, and assess the clinical outcome. Methods We selected 226 tuberculous meningitis patients combined with moderate or severe hydrocephalus. All patients were nonrandomly divided into two groups： the treatment group adopted the modified ventricular drainage which included 127 patients, the control group adopted conventional ventricular drainage which included 99 patients, all patients underwent a standard systemic anti-TB, dehydration and corticosteroids therapy. The treatment group adopted modified ventricular drainage under localized anesthesia, but as for the control group ,we adopted the conventional way which punctured through frontal eminence. All patients of the two groups were injected anti-TB drugs into lateral ventricles each day since the second day after the operation. Two weeks later, we pinched off the catheter for 24 hours as a trial, assessed the possibility of extubating the catheter according to the standard of extubation, and determined the efficacy. Results In the treatment group, 76 cases were extubated the catheter in the drainage time window, 19 cases ahead of the time, 32 cases after the time,and the average retention time was （27.6＋17.3）d, 3 cases suffered secondary intracranial infection, with a total efficiency of 74.8%（95/127）, intracranial infection rate of 2.3%. As the control group, 56 cases were extubated the catheter in the drainage time window, 29 cases ahead of the time, 14 eases after the time,and the average retention time was （18.9＋_15.2） d, 7 cases suffered secondary intracranial infection, with a total efficiency of 69.7%（69/99）, intracranial infection rate of 7.1%. We observed that there was no statistically significant difference of efficiency （~2=3.75, P 〉0.05）,but statistically significant difference of retention time（t=2.413,P 〈 0.05）and secondary intracranial infection 0（2=-4.92 ,
出处
《中国现代医生》
2013年第32期48-50,共3页
China Modern Doctor
基金
江西省卫生厅科技计划项目资助(20081142)
关键词
结核性脑膜炎
脑积水
引流
Tuberculous meningitis
Hydrocephalus
Drainage
