脑室冲洗与常规脑脊液置换在脑脊液蛋白增高脑积水中的比较研究

Ventricular irrigation versus conventional CSF exchange in hydrocephalus with an elevated CSF protein level

摘要:

目的 比较脑室冲洗与常规脑脊液置换在脑脊液蛋白增高脑积水中的应用价值。方法 选取我院2015年1月至2018年8月确诊为脑脊液蛋白增高脑积水病人90例。随机分成脑室冲洗组、脑室外引流组和腰大池外引流组，每组30例。脑室冲洗组行两侧脑室冲洗；脑室及腰大池外引流组行脑室和腰大池引流，3组病人脑脊液蛋白﹤500 mg/L后行脑室腹腔分流术。观察术后7 d、14 d脑脊液蛋白含量、等待分流手术的时间、颅内感染及堵管发生率。结果 脑室冲洗组等待分流手术的时间1.87 d，明显短于两常规组（P<0.01），术后7 d脑脊液蛋白含量523.45 mg/L，明显高于两对照组（P<0.05），14 d后无明显差异。脑室外引流组颅内感染发生率30%，明显高于脑室冲洗组（P<0.05）。3组堵管发生率没有明显差异。结论 脑室冲洗能明显加快脑脊液蛋白增高脑积水病人的手术进程，值得推广应用。

Abstract:

Objective To compare the value of ventricular irrigation and conventional cerebrospinal fluid (CSF) exchange in hydrocephalus with an elevated CSF protein level.Methods We selected 90 patients diagnosed with hydrocephalus and an elevated CSF protein level in our hospital from January 2015 to August 2018. They were randomly divided into three groups:ventricular irrigation group, external ventricular drainage group, and external lumbar drainage group, with 30 cases in each group. When the CSF protein concentration was <500 mg/L, ventriculoperitoneal shunt surgery would be performed. We recorded CSF protein concentrations at 7 d and 14 d after surgery, time to shunting, and the incidence of intracranial infection and drain blockage.Results Time to shunt operation was 1.87 d in the ventricular irrigation group, significantly shorter than that in both conventional groups (P<0.01). The CSF protein level averaged 523.45 mg/L in the ventricular irrigation group at 7 d after operation, significantly higher than those in the two control groups (P<0.05), but showed no significant differences between the three groups at 14 d post operation. In the external ventricular drainage group, 30% developed intracranial infection, which was significantly higher than that in the ventricular irrigation group (P<0.05). There was no significant difference in the incidence of drain blockage between the three groups.Conclusions Ventricular irrigation can significantly bring forward shunt operation for patients with hydrocephalus and an elevated CSF protein level, showing promise for clinical application.