PRELIMINARY EXPERIENCE WITH CONTROLLED EXTERNAL LUMBAR DRAINAGE IN DIFFUSE PEDIATRIC HEAD-INJURY
PRELIMINARY EXPERIENCE WITH CONTROLLED EXTERNAL LUMBAR DRAINAGE IN DIFFUSE PEDIATRIC HEAD-INJURY
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DOI：
10.1159/000120579
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发表时间：
1992-01-01
影响因子：
0.7
通讯作者：
REKATE, HL
中科院分区：
文献类型：
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作者：
BALDWIN, HZ;REKATE, HL
我们对5例严重弥漫性颅脑损伤患儿采用腰椎蛛网膜下腔外引流的经验进行了报告。所有患者在受伤后24小时格拉斯哥昏迷评分为8分或更低，并最初接受脑室造口术治疗。两名儿童需要手术切除局灶性肿块。入院72小时内，所有患儿均表现出高颅内压（ICP），包括过度通气、速尿、甘露醇和巴比妥酸盐昏迷。采用腰椎引流术后，5例患儿中有3例ICP突然持续下降，无需继续使用巴比妥类药物和过度通气。3名儿童幸存，其中2名康复良好；1名儿童功能残疾。幸存患者的颅内压随引流袋高度被动变化。两名患者死亡，很可能是在腰椎引流管放置前未受控制的ICP。我们的结论是，当最大的药物治疗和脑室脑脊液（CSF）排出未能控制高颅内压时，控制性腰椎蛛网膜下腔外引流是一种潜在的有效治疗方法。创伤后脑脊液循环中断，白质脑水肿和颅内静脉高压在没有局灶性肿块病变的情况下可以用这种方式治疗。
Our experience with the use of external lumbar subarachnoid drainage in 5 children with severe diffuse head injuries is presented. All patients had Glasgow Coma Scale scores of 8 or less at 24 h after injury and were initially treated with ventriculostomies. Two children required surgical evacuation of focal mass lesions. Within 72 h of admission, all children manifested high intracranial pressures (ICP) refractory to maximal therapy, including hyperventilation, furosemide, mannitol, and barbiturate coma. After the institution of lumbar drainage 3 of the 5 children had an abrupt and lasting decrease in ICP, obviating the need for continued barbiturates and hyperventilation. Three children survived, 2 of whom made good recoveries; 1 child is functional with disability. ICP varied passively with the height of the drainage bag in these surviving patients. Two patients died, most likely from uncontrolled ICP before the lumbar drain was placed. We conclude that controlled external lumbar subarachnoid drainage is a potentially useful treatment for severe diffuse pediatric head injury when maximal medical therapy and ventricular cerebrospinal fluid (CSF) evacuation have failed to control high ICP. Posttraumatic CSF circulation disruption, white matter cerebral edema, and intracranial venous hypertension can be treated with this modality in the absence of focal mass lesions.