脑室、腰池外引流的应用与管理

目的探讨脑室、腰池外引流管的应用与管理,总结减少分流依赖性脑积水及颅内感染的经验。方法回顾性分析连续收治的102例破裂动脉瘤夹闭后对蛛网膜下腔出血的处理及28例脑室出血或积血脑室外引流的放置方法及疗效。破裂动脉瘤病人中,术中留置脑室外引流51例,术后行腰池引流或腰穿9例;对脑室出血病人均行脑室外引流。术中采用聚乙烯吡咯烷酮碘进行硬膜外冲洗;在留置脑室、脑池外引流期间,引流管内压力保持10～15cm H2O。结果本组外引流放置时间2～24d,术后无颅内感染发生。仅出现分流依赖性脑积水3例,均为动脉瘤病人。结论保持10～15cm H2O的脑室、脑池外引流压力及预防颅内感染是减少分流依赖性脑积水的重要措施。

Application and management of external ventricular or cisternal drainage

Objective To explore the application and management of external ventricular or cistemal drainage, and to summarize the experiences in reducing shunt-dependent hydrocephalus and intracranial infection. Methods Management of subarachnoid hemorrhage after clipping of ruptured aneurysm in 102 consecutive patents, method of drain placement for cerebroventricular＇bleeding or hematocele and the therapeutic efficacy in 28 patients were analyzed retrospectively. In patients with aneurysms, 51 received external cerebral cistern drainage and 9 external lumber cistern drainage or puncture. All the cerebroventricular hematoma patients underwent external drainage. External ventricular or cistemal drainage pressure was kept at 10-15 cm H2O and the extradural area was rinsed with PVP-1 during surgery. Results No intracranial infection occurred in all the patients. Only 3 aneurysm patients developed shunt-dependent hydrocephalus. Conclusion Keeping 10-15 cm H2O external ventricular or cistemal drainage pressure and preventing intracranial infection are very important procedures for reducing shunt-dependent hydrocephalus.