背景:颅内高压常用的临床治疗方法包括持续腰大池脑脊液引流(CLCFD)和常规腰穿。然而,腰椎穿刺更具侵入性,需要多次穿刺。CLCFD创伤较小,并且可以操纵引流以避免重复的腰椎穿刺。然而,CLCFD也可能导致并发症,如颅内血肿和颅内气胸。因此,没有关于哪种方法更有效的协议。本研究评价CLCFD与常规腰穿治疗颅脑损伤后脑脊液漏的疗效。
方法:检索词\'脑损伤\'和\'CLCFD\'用于检索CNKI,万方,VIP,龙源,PubMed,Embase,Cochrane图书馆和其他数据库(从成立到2022年11月1日)。纳入标准:(I)随机对照试验(RCT),CLCFD和常规腰穿引流术对颅脑损伤后脑脊液漏患者的影响;(二)评价脑脊液漏停止时间、清关时间,颅内感染和并发症。进行Cochrane系统评价以评估文献质量。采用RevMan5.3软件进行系统分析。
结果:共8项研究,涉及568名患者。统计数据中存在一些出版偏差。脑脊液漏停止时间(95%置信区间(CI):-3.65~-2.86,Z=16.21,P<0.00001),恢复正常压力的时间(95%CI:-3.13~-2.09,Z=9.79,P<0.00001),脑脊液清除时间(95%CI:-1.96~-1.09,Z=6.91,P<0.00001),住院时间(95%CI:-1.99~-0.91,Z=5.27,P<0.00001),CLCFD组颅内感染发生率(95%CI:0.07~0.27,Z=5.84,P<0.00001)和并发症发生率(95%CI:0.10~0.43,Z=4.22,P<0.0001)均低于常规组。CLCFD组治愈率明显高于常规组(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)。
结论:与常规腰椎穿刺相比,CLCFD可以显著提高治愈率,缩短脑脊液恢复时间,并显著降低颅内感染的发生率,减少并发症,有利于患者的预后。
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.