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Summary of best evidence for prevention and management of intracranial infections related to lumbar drainage

Objective To retrieve, evaluate, and summarize evidence on the prevention and management of intracranial infections related to lumbar drainage (LD), in order to provide scientific references for clinical practice and decision-making. Methods The literature on the prevention and management of LD-related intracranial infections in LD-related websites and databases was systematically searched, with a search period from the establishment of databases to June 30, 2024. The included literature was evaluated for quality and integrated into evidence. Results A total of 9 articles were included, including 3 guidelines, 1 evidence summary, 1 expert consensus, 1 systematic review, and 3 original studies. A total of 30 pieces of evidence were formed, covering six aspects: risk management, catheter placement, catheter maintenance, extubation, diagnosis and treatment of intracranial infections, education and training. ConclusionsThe prevention and management of LD-related intracranial infections involve multiple pieces of evidence, and medical staff should selectively apply the best evidence based on patient and clinical conditions to reduce the incidence of intracranial infections and improve medical quality.

Effectiveness of Continuous Lumbar Drainage for CSF Leakage: A Systematic Review

ObjectiveTo systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. MethodsA comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. ResultsSeven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). ConclusionCurrent evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.

腰大池引流腦脊液治療主動脈夾層術后截癱六例

顯微血腫清除及去大骨瓣減壓手術聯合亞低溫和腰大池引流治療重癥原發性腦出血

目的　總結應用顯微血腫清除及去大骨瓣減壓手術聯合亞低溫和腰大池引流治療重癥原發性腦出血的臨床效果。 方法　對2010年2月－2012年2月141例重癥原發性腦出血患者，分別采用保守治療（保守組32例）、常規開顱顯微手術血腫清除治療（對照組55例）及去大骨瓣顯微手術聯合亞低溫及腰大池引流治療（治療組54例）三種方法進行治療，并對3個月后的病死率及日常生活活動能力（ADL）進行比較分析。 結果　結果保守組32患者中死亡17例（病死率53.1%），對照組55例患者中死亡22例（病死率40.0%），治療組54例患者中死亡19例（病死率35.2%），3組間患者病死率差異有統計學意義（P＜0.05），治療組的病死率明顯低于保守組和對照組，差異均有統計學意義（P＜0.05）。治療組ADL分級1～3級患者明顯多于保守組和對照組（P＜0.01）。 結論　顯微血腫清除及去大骨瓣減壓手術聯合亞低溫和腰大池引流治療重癥原發性腦出血可以降低患者病死率低，提高患者生活質量。