方法 2008年9月-2009年11月，將20例顱腦外傷后顱內感染患者分為腦脊液外引流組和抗生素組各10例，外引流組進行持續腰池置管腦脊液外引流，定期取引流腦脊液進行常規和生化檢查；抗生素組采用靜脈抗生素治療。對兩組顱內感染情況進行對比分析。 結果 外引流組經持續腰池置管腦脊液外引流治療后，顱內感染臨床癥狀明顯緩解，腦脊液有核細胞數和腦脊液微量蛋白含量顯著降低、腦脊液葡萄糖和氯化物濃度升高（Plt;0.05）。治療10 d后，外引流組體溫、腦脊液有核細胞數、腦脊液微量蛋白含量、腦脊液葡萄糖和氯化物濃度的改善程度明顯優于抗生素組（Plt;0.05）。 結論 持續腰池置管腦脊液外引流治療顱內感染具有安全性高、操作簡便、觀察顱內感染情況方便的優點，可作為顱內感染可靠治療手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
Objective To systematically evaluate posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for Chiari malformation type I (CM-I). Methods A meta-analysis was performed according to the guideline of the MOOSE statement. Relevant literature and references were electronically searched in CENTRAL, Science Citation Index Expanded, MEDLINE (Ovid), PubMed, CBM, CNKI and WanFang Data from 1993 to September 2011. Two reviewers independently identified literature according to inclusion and exclusion criteria. The included studies were evaluated using the Newcastle-Ottawa Scale. Original data were extracted and analyzed using RevMan 5.1 software. Besides, the level of evidence was assessed using the GRADE system. Results Ten studies involving 829 patients were included. The results of meta-analyses showed that: a) compared with patients undergoing PFD, patients undergoing PFDD had a significantly lower reoperation rate (RR=0.41, 95%CI 0.23 to 0.74, P=0.003), and a higher rate of syringomyelia decrease (RR=1.27, 95%CI 1.03 to 1.56, P=0.02). But there was no significant difference in clinical improvement (RR=1.11, 95%CI 0.95 to 1.28, P=0.18). b) compared with PFD, patients undergoing PFDD had a higher rate of cerebrospinal fluid–related complications (RR=6.3, 95%CI 2.71 to 14.67, Plt;0.000 1). There were no significant differences in the complication of occipital neuralgia and wound infection (Pgt;0.05). Based on GRADE system, the evidence was at Level C and we made a weak recommendation. Conclusion Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation, a better effect of syringomyelia decrease and a greater risk for cerebrospinal fluid–related complications, compared with PFD. Due to the influencing factors of lower-quality included studies, a prudent choice is suggested, and also more high-quality, large-sample studies are need.
