Feng Shejun, Lv Xuehai, Dai Xiaomin
Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Rehabilitation, Handan Central Hospital, Handan, China.
Ann Palliat Med. 2023 Jan;12(1):121-132. doi: 10.21037/apm-22-1302.
Commonly used clinical treatments for intracranial hypertension include continuous lumbar cerebrospinal fluid drainage (CLCFD) and conventional lumbar puncture. However, lumbar puncture is more invasive, requires multiple punctures. CLCFD has less trauma, and drainage can be manipulated to avoid repeated lumbar puncture. However, CLCFD may also lead to complications such as intracranial hematoma and intracranial pneumothorax. Therefore, there is no agreement on which method is more effective. This study evaluated the efficacy of CLCFD and conventional lumbar puncture in the treatment of cerebrospinal fluid leakage after craniocerebral injury.
The search terms 'brain injury' and 'CLCFD' were used to search CNKI, Wanfang, VIP, Longyuan, PubMed, Embase, Cochrane Library and other databases (from inception to November 1, 2022). Inclusion criteria: (I) randomized controlled trials (RCTs), CLCFD and conventional lumbar puncture drainage for patients with cerebrospinal fluid leakage after craniocerebral injury; (II) evaluation of indicators such as cerebrospinal fluid leakage stop time, clearance time, intracranial infection and complications. Cochrane systematic review was performed to assess the quality of the literature. RevMan 5.3 software was used for systematic analysis.
A total of 8 studies, involving 568 patients. There is some publication bias in the statistics. The cessation time of cerebrospinal fluid leakage (95% confidence interval (CI): -3.65 to -2.86, Z=16.21, P<0.00001), the time to return to normal pressure (95% CI: -3.13 to -2.09, Z=9.79, P<0.00001), cerebrospinal fluid clearing time (95% CI: -1.96 to -1.09, Z=6.91, P<0.00001), hospitalization time (95% CI: -1.99 to -0.91, Z=5.27, P<0.00001), incidence of intracranial infection (95% CI: 0.07-0.27, Z=5.84, P<0.00001) and complications (95% CI: 0.10-0.43, Z=4.22, P<0.0001) in the CLCFD group were lower than those in the conventional group. The cure rate of the CLCFD group was significantly higher than that of the conventional group (OR =3.75, 95% CI: 2.26-6.23, Z=5.11, P<0.00001); the difference in mortality between the two groups was not statistically significant (P>0.05).
Compared with conventional lumbar puncture, CLCFD can significantly increase the cure rate, shorten the recovery time of cerebrospinal fluid, and significantly reduce the incidence of intracranial infections, reduce complications, is conducive to the prognosis of patients.
颅内高压常用的临床治疗方法包括持续腰椎脑脊液引流（CLCFD）和传统腰椎穿刺。然而，腰椎穿刺的侵入性更强，需要多次穿刺。CLCFD创伤较小，且可操控引流以避免重复腰椎穿刺。然而，CLCFD也可能导致颅内血肿和颅内气胸等并发症。因此，对于哪种方法更有效尚无定论。本研究评估了CLCFD和传统腰椎穿刺在治疗颅脑损伤后脑脊液漏中的疗效。
使用检索词“脑损伤”和“CLCFD”检索中国知网、万方、维普、龙源、PubMed、Embase、Cochrane图书馆等数据库（自建库至2022年11月1日）。纳入标准：（I）随机对照试验（RCT），对颅脑损伤后脑脊液漏患者采用CLCFD和传统腰椎穿刺引流；（II）评估脑脊液漏停止时间、清除时间、颅内感染及并发症等指标。采用Cochrane系统评价对文献质量进行评估。使用RevMan 5.3软件进行系统分析。
共纳入8项研究，涉及568例患者。统计存在一定发表偏倚。CLCFD组脑脊液漏停止时间（95%置信区间（CI）：-3.65至-2.86，Z=16.21，P<0.00001）、恢复正常压力时间（95%CI：-3.13至-2.09，Z=9.79，P<0.00001）、脑脊液清除时间（95%CI：-1.96至-1.09，Z=6.91，P<0.00001）、住院时间（95%CI：-1.99至-0.91，Z=5.27，P<0.00001）、颅内感染发生率（95%CI：0.07 - 0.27，Z=5.84，P<0.00001）及并发症发生率（95%CI：0.10 - 0.43，Z=4.22，P<0.0001）均低于传统组。CLCFD组治愈率显著高于传统组（OR =3.75，95%CI：2.26 - 6.23，Z=5.11，P<0.00001）；两组死亡率差异无统计学意义（P>0.05）。
与传统腰椎穿刺相比，CLCFD可显著提高治愈率，缩短脑脊液恢复时间，显著降低颅内感染发生率，减少并发症，有利于患者预后。
