摘要
目的 探讨脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症的临床治疗方法及疗效。方法 将83例脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症患者分为观察组（n=42）与对照组（n=41）,入院后均行常规给予扩血管药物、改善脑循环药物以及抗抑郁药物进行对症治疗,对照组患者加行传统反复腰穿方法释放脑脊液,同时于鞘内注入稀释头孢曲松5~10 ml,1次/d;观察组采用腰大池置管持续引流进行治疗,同时经引流管行鞘内注射稀释头孢曲松5~10 ml,2~3次/d,另再加行高压氧治疗,比较两组治疗效果。结果 观察组的临床症状缓解时间与感染控制平均时间均显著短于对照组（P〈0.001）,脑脊液漏治愈及感染完全控制患者比例显著高于对照组（P〈0.01）,重残率及死亡率显著低于对照组（P〈0.05）;同时头颅CT检查结果显示,治疗后观察组颅内积气消失,对照组虽有一定程度缩小,但颅内积气仍然存在;治疗后两组患者的SAS、SDS评分均较治疗前显著降低,且观察组评分低于对照组,差异均有统计学意义（P〈0.001）。结论 采用腰大池置管持续引流联合高压氧治疗脑外伤术后脑脊液漏伴颅内感染焦虑抑郁症疗效满意,建议在临床广泛推广应用。
Objective To explore the clinical treatment methods and curative effect of post-operative cerebrospinal fluid leakage with intracranial infection,anxiety and depression in patients with brain injury. Methods Eighty-three brain trauma patients with postoperative cerebrospinal fluid leakage and intraeranial infection as well as anxiety and depression were divided into observation group （n = 42） and control group （n = 41 ）. Patients in the both groups routinely received symptomatic treatment with vasodilators, cerebral circulation improving drugs and antidepressant drugs. Patients in the control group received a series of traditional lumbar puncture to release cerebrospinal fluid and intratheeal injection of dilute ceftriaxone 5 - 10 ml/times/d. Patients in the observation group had lumbar puncture continuous drainage treatment with intrathecal injection of ceftriaxone diluted 5 - 10 ml/2 - 3 times/d and HBO treatment. The clinical effect was compared between the two groups. Results The clinical symptoms remission time and average time of infection control in the observed group was significantly shorter than those in the control group （P 〈 0. 001 ）. The cure rate of cerebrospinal fluid leakage and infection in the observation group was significantly higher than that in the control group （P 〈 0. 01 ）. The rate of severe disability and mortality in the observation group was significantly lower than those in the control group （P 〈 0. 05）. The cranial CT examination showed that the pneumocephalus disappeared in the observation group after treatment while intracranial gas existed although it was narrowed in a certain degree in the control group. SAS and SDS scores were significantly reduced after the treatments when com- pared to before treatment and the observation group was significantly lower than the control group （ all P 〈 0. 001 ）. Conclusion The lumbar catheter drainage combined with continued HBO treatment for brain trauma patients with postoperative cerebrospinal fluid leak- age associated with intracranial infection, anxiety and depression is satisfactory. It is recommended for widespread clinical application.
出处
《实用医院临床杂志》
2016年第5期83-86,共4页
Practical Journal of Clinical Medicine
关键词
脑外伤
脑脊液漏
颅内感染
焦虑
抑郁
Brain injury
Cerebrospinal fluid leakage
Intracranial infection
Anxiety
Depression
