摘要
目的探讨侧脑室钻孔引流术结合腰大池持续引流术(lumbar cistern countinue drainage,LCFD)治疗老年脑室出血的有效性,并分析术后并发颅内感染的Logistic的危险因素。方法前瞻性选取本院2015年9月至2020年3月接诊的老年脑室出血患者88例,按照随机数字表法将患者分为对照组和研究组,每组44例。对照组采取侧脑室钻孔引流术治疗,研究组采取侧脑室钻孔引流术联合LCFD治疗。比较两组患者疗效、治疗前后格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、格拉斯哥预后评分(Glasgow Outcome Scale,GOS)以及血肿清除效果(包括血肿清除时间、术后3d血肿清除率)以及颅内感染发生情况,采用单因素、多因素Logistic回归分析术后并发颅内感染的危险因素。结果研究组治疗总有效率(90.9%)显著高于对照组(71.5%)(χ^(2)=5.91,P<0.05)。治疗前患者GCS评分、GOS评分无差异(P>0.05),治疗后均升高(P<0.05),且研究组GCS评分(13.66±3.11)、GOS评分(4.78±0.66)显著高于对照组(t=5.44,9.89,P<0.05)。研究组血肿清除时间(5.68±1.52)h低于对照组,且术后3d血肿清除率(91.33±4.30)%显著大于对照组(t=8.81、9.00,P<0.05)。14例患者发生术后颅内感染(15.9%),单因素、多因素Logistic回归分析显示:糖尿病(OR=23.477,95%CI 0.279~50.350)、手术切口皮肤感染(OR=48.135,95%CI 4.388~528.013)以及手术时机(OR=10.633,95%CI 1.203~94.021)是影响老年脑室出血患者手术后并发颅内感染的独立危险因素(P<0.05)。结论侧脑室钻孔引流术联合LCFD治疗老年脑室出血疗效确切,能够缩短血肿清除时间,改善昏迷状况和预后,糖尿病、手术时机和术后切口感染是导致术后颅内感染的危险因素,该类患者临床应该预先进行干预和预防。
Objective To investigate the effectiveness of lateral ventricle drilling drainage combined with lumbar cistern continuous drainage(LCFD)in the treatment of elderly patients with intraventricular hemorrhage,and to analyze the logistic risk factors of postoperative intracranial infection.Methods 88 elderly patients with intraventricular hemorrhage in our hospital from September 2015 to March 2020 were prospectively selected and randomly divided into control group and study group,with 44 cases in each group.The control group was treated with lateral ventricle drilling and drainage,and the study group was treated with lateral ventricle drilling and drainage combined with LCFD.The curative effect,Glasgow Coma Scale(GCS)and Glasgow outcome score before and after treatment were compared between the two groups The risk factors of postoperative intracranial infection were analyzed by univariate and multivariate logistic regression.Results The total effective rate of the study group was significantly higher than that of the control group(χ^(2)=5.91,P<0.05).There was no difference in GCS score and GOS score before treatment(P>0.05),but increased after treatment(P<0.05).GCS score and GOS score of study group were significantly higher than those of control group and t=5.44,9.89,P<0.05).The hematoma clearance time of the study group was lower than that of the control group,and the hematoma clearance rate 3 days after operation was significantly higher than that of the control group(t=8.81,9.00,P<0.05).A total of 14 patients(15.9%)had postoperative intracranial infection.Univariate and multivariate logistic regression analysis showed that diabetes mellitus(OR=23.477,95%CI 0.279~50.350),skin infection of surgical incision(OR=48.135,95%CI 4.388~528.013)and timing of operation(OR=48.135,95%CI 4.388~528.013)were the main causes of postoperative intracranial infectio(OR=633,95%CI 1.203~94.021)was an independent risk factor for postoperative intracranial infection in elderly patients with intraventricular hemorrhage(P<0.05).Conclusi
作者
姚成成
申洁心
YAO Chengcheng;SHEN Jiexin(Shandong Linglong Yingcheng Hospital,neurosurgery;laboratory, Shandong, Yantai 265400, China)
出处
《中国老年保健医学》
2022年第1期30-34,共5页
Chinese Journal of Geriatric Care
