腰大池持续外引流术对预防Chiari畸形Ⅰ型术后并发症的临床研究

发布时间：2018-03-07 07:02

本文选题：腰大池持续引流　切入点：Chiari畸形　出处：《济南大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的评价腰大池持续外引流术对预防Chiari畸形I型术后并发症发生的有效性及安全性。方法选取我院2013年1月-2014年5月收治的chiari畸形I型患者60例,所有换均合并不同程度的脊髓空洞。将入选患者随机分为2组,治疗组30和对照组30例。治疗组在术后第1天行腰大池置管外引流,对照组在术后第1天未行腰大池置管外引流,治疗一周后,采用自身前后对比及实验组与对照组组间对比的方法,观察两组患者同步、定期脑脊液生化指标检测结果中白细胞、氯化物含量、葡萄糖含量及蛋白定量指标的变化情况。同时观察两组患者术后并发症如术后发热、皮下积液、切口脑脊液漏、颅内感染的发生率情况,以及切口愈合情况及住院时间的变化情况。结果1、两组同步脑脊液生化指标比较脑脊液生化指标检查结果示:治疗组的白细胞计数及蛋白定量呈明显下降趋势,对照者的则呈缓慢下降趋势,两组有明显统计学意义(P0.05)2、两组术后并发症的发生率的比较治疗组术后无一例患者发生颅内感染,对照组有5例患者发生颅内感染,两组比较p=0.071,其差异有统计学意义。治疗组术后有一例患者出现皮下积液,对照组有4例患者发生皮下积液,两组比较p=0.056,差异无统计学意义。3、两组术后住院时间的比较治疗组平均住院天数为(10.564±2.236)天,对照组(14.354±1.532)天,两组差异有统计学意义(P0.01)。4、两组术后切口愈合情况比较治疗组与对照组切口均愈合良好,均未出现脑脊液漏,两组比较无差异,无统计学意义。结论Chiari畸形I型术后常规给予腰穿置管脑脊液外引流术能有效预防术后颅内感染、皮下积液、脑脊液漏及脑积水的发生,能有效减少抗生素的应用、缩短住院时间以减轻患者的经济负担,具有较好的临床疗效,值得临床推广。
[Abstract]:Objective to evaluate the efficacy and safety of continuous external drainage of lumbar cistern for the prevention of postoperative complications of Chiari malformation type I. methods 60 patients with type I chiari malformation admitted in our hospital from January 2013 to May 2014 were selected. All the patients with syringomyelia were randomly divided into two groups: treatment group (n = 30) and control group (n = 30). After one week of treatment, the patients in the control group were compared with each other before and after treatment. The white blood cells of the two groups were observed synchronously and periodically, and the results of cerebrospinal fluid biochemical indexes were measured regularly. The changes of chloride content, glucose content and protein quantitative index were also observed. The incidence of postoperative complications such as postoperative fever, subcutaneous effusion, cerebrospinal fluid leakage and intracranial infection were observed in both groups. Results 1.Compared with the biochemical indexes of cerebrospinal fluid in the two groups, the results showed that the white blood cell count and protein quantity of the treatment group were obviously decreasing. The incidence of postoperative complications in the two groups was significantly higher than that in the control group. There was no intracranial infection in the treatment group and 5 patients in the control group. The difference between the two groups was statistically significant. One patient in the treatment group had subcutaneous effusion after operation, and four patients in the control group had subcutaneous effusion. There was no significant difference between the two groups. The average length of hospitalization was 10.564 卤2.236 days in the treatment group and 14.354 卤1.532 days in the control group. There was significant difference between the two groups (P 0.01). There was no significant difference between the treatment group and the control group in the wound healing, and no cerebrospinal fluid leakage was found in the treatment group and the control group, but there was no difference between the two groups. Conclusion the routine drainage of cerebrospinal fluid through lumbar puncture can effectively prevent the occurrence of intracranial infection, subcutaneous effusion, cerebrospinal fluid leakage and hydrocephalus, and can effectively reduce the use of antibiotics. Shortening the hospitalization time to reduce the economic burden of patients has better clinical effect and is worth popularizing.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.2

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