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经皮脑室造瘘术与脑实质内监测的比较:156例患者的回顾性评估

Comparison of percutaneous ventriculostomies and intraparenchymal monitor: a retrospective evaluation of 156 patients.

作者信息

Khan S H, Kureshi I U, Mulgrew T, Ho S Y, Onyiuke H C

机构信息

Department of Neurosurgery Head Injury Program, Hartford Hospital, University of Connecticut School of Medicine, Hartford, USA.

出版信息

Acta Neurochir Suppl. 1998;71:50-2. doi: 10.1007/978-3-7091-6475-4_16.

Abstract

Intraventricular catheters (IVC) and Intraparenchymal fiberoptic catheters (IPC) are the prevalent methods of intracranial pressure (ICP) monitoring. This study assesses the complications caused by either method. Previous studies have shown a higher complication rate with IVC. In 156 consecutive patients, with IVC (n = 104) or IPC (n = 52) insertion, the demographics, Glasgow coma score (GCS), ICP, duration of monitoring, changes in monitoring device, complications and computerized tomography findings, were recorded. The patients were categorized into severe (GCS 3-8), moderate (GCS 9-12) and mild (GCS 13-15) groups. A retrospective, comparative analysis of both techniques was conducted, using Kruskal-Wallis one way analysis of variance with chi square approximation and Mann-Whitney U tests. The use of IPC at 86.5% predominated in patients with GCS 3-8, while IVC at 81.4% and 92% prevailed in GCS groups 9-12 and 13-15, respectively (p = 0.000). 43.2% IVC were used for 10+ days and 25.9% for 1-3 days, while 80% of IPC were used for less than 6 days (p = 0.000). The complication rate for IVC and IPC was 25% vs 4.4% (p = 0.000). The infection rate was 4.4% and 0.6% (p = 0.1) while, inadvertent removal 4.4% vs 1.2% (p = 0.4), respectively. Malpositions occurred only with IVC (20.1%). All documented complications were without untoward clinical sequelae. We conclude that, IVC remains comparable to IPCs in complications.

摘要

脑室内导管(IVC)和脑实质内光纤导管(IPC)是颅内压(ICP)监测的常用方法。本研究评估了这两种方法所引起的并发症。既往研究表明IVC的并发症发生率更高。在156例连续接受IVC(n = 104)或IPC(n = 52)置入的患者中,记录了人口统计学资料、格拉斯哥昏迷评分(GCS)、ICP、监测持续时间、监测设备的更换情况、并发症以及计算机断层扫描结果。患者被分为重度(GCS 3 - 8)、中度(GCS 9 - 12)和轻度(GCS 13 - 15)组。采用Kruskal - Wallis单向方差分析及卡方近似法和Mann - Whitney U检验对这两种技术进行回顾性比较分析。在GCS 3 - 8的患者中,86.5%的患者使用IPC,而在GCS 9 - 12组和13 - 15组中,分别有81.4%和92%的患者使用IVC(p = 0.000)。43.2%的IVC使用时间为10天以上,25.9%的使用时间为1 - 3天,而80%的IPC使用时间少于6天(p = 0.000)。IVC和IPC的并发症发生率分别为25%和4.4%(p = 0.000)。感染率分别为4.4%和0.6%(p = 0.1),意外拔除率分别为4.4%和1.2%(p = 0.4)。仅IVC出现了置管位置不当的情况(20.1%)。所有记录的并发症均未导致不良临床后果。我们得出结论,IVC在并发症方面与IPC相当。

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