Abrishamkar Saeid, Khalighinejad Nima, Moein Payam
Department of Neurosurgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Acta Med Iran. 2013 Aug 7;51(7):467-71.
In this study, we examined the role of early acetazolamide administration in reducing the risk of cerebrospinal fluid (CSF) leakage in patients with a high risk of permanent CSF leakage. In a randomised clinical trial, 57 patients with a high risk of permanent CSF leakage (rhinorrhea, otorrhea, pneumatocele or imaging-based evidence of severe skull-base fracture) were analysed. In the experimental group, acetazolamide, at 25 mg/kg/day, was started in the first 48 hours after admission. In the control group, acetazolamide was administered after the first 48 hours at the same dose administered to the patients in the experimental group. The following factors were compared between the two groups: duration of CSF leakage, duration of hospital stay, incidence of meningitis, need for surgical intervention and need for lumbar puncture (LP) and lumbar drainage (LD). All of the patients in the experimental group stopped having CSF leakage less than 14 days after the first day of admission, but 6 out of 21 patients (22%) in the control group continued having CSF leakage after 14 days of admission, which was a significant difference (P=0.01). This study showed that early acetazolamide administration can prevent CSF leakage in patients with a high risk of permanent CSF leak.
在本研究中，我们探讨了早期给予乙酰唑胺在降低永久性脑脊液漏高危患者脑脊液漏风险中的作用。在一项随机临床试验中，分析了57例永久性脑脊液漏高危患者（鼻漏、耳漏、气囊肿或基于影像学的严重颅底骨折证据）。在实验组中，入院后48小时内开始给予乙酰唑胺，剂量为25mg/kg/天。在对照组中，乙酰唑胺在入院48小时后给予，剂量与实验组患者相同。比较了两组之间的以下因素：脑脊液漏持续时间、住院时间、脑膜炎发生率、手术干预需求以及腰椎穿刺（LP）和腰椎引流（LD）需求。实验组所有患者在入院第一天后不到14天就停止了脑脊液漏，但对照组21例患者中有6例（22%）在入院14天后仍持续有脑脊液漏，差异有统计学意义（P=0.01）。本研究表明，早期给予乙酰唑胺可预防永久性脑脊液漏高危患者的脑脊液漏。
