| 标题： | 神经外科重症患者脑脊液外引流管理专家共识 |
| title： | Expert consensus on cerebrospinal fluid external drainage management in neurosurgery critical patients |
| 版本： | 更新版 |
| version： | Updated |
| 分类： | 专家共识 |
| classification： | Experts consensus |
| 领域： | 治疗 |
| field： | Treatment |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 各级神经外科重症病房 |
| Guide users： | Neurosurgical intensive care units at all levels |
| 证据分级方法： | 牛津循证医学中心证据分级系统 |
| Evidence grading method： | Oxford evidence based medicine center evidence grading system |
| 制定单位： | 中国神经外科重症管理协作组 |
| Formulating unit： | Chinese Neurosurgical Critical Care Specialist Council |
| 注册时间： | 2024-10-24 |
| Registration time： | |
| 注册编号： | PREPARE-2024CN913 |
| Registration number： | |
| 指南制订的目的： | 脑脊液外引流是一种神经外科常用的治疗技术，它包括脑室外引流（External Ventricular Drainage，EVD）和腰大池外引流（Lumbar cistern drainage，LD）。主要用于将脑室或腰大池内的脑脊液通过密闭系统持续引流至体外，以释放血性或感染的脑脊液，也可用于监测和控制颅内压以及经引流管注射药物。脑脊液外引流适用于脑出血伴急性脑积水、蛛网膜下腔出血、颅内高压、颅内感染等情况。然而，这两种引流方式也存在禁忌症，如EVD相对禁忌于出凝血功能障碍和穿刺部位感染的患者，而LD则禁忌于急性脑疝、颅内压严重增高、腰椎畸形或骨质破坏、全身严重感染、高颈段脊髓占位性病变以及脑脊液循环通路不完全梗阻的患者。在实施这些引流技术时，应根据患者的具体情况和病情变化，综合评估适应症和禁忌症，以确保治疗的安全性和有效性。 脑脊液外引流的围手术期管理是治疗成功的关键，包括引流管的选择，引流量的调节、引流管的拔除以及并发症的处理。虽然脑脊液外引流的技术门槛低，各级医院均能完成，但关于引流管管理的相关问题并没有达成统一意见。因此，中华医学会神经外科分会、中国神经外科重症管理协作组组织神经外科重症领域专家应用循证医学证据结合专家意见的方法，在2018年《神经外科重症患者脑脊液外引流管理专家共识》的基础上重新进行了撰写，制定了《神经外科重症患者脑脊液外引流管理专家共识（2024）》。 |
| Purpose of the guideline： | External cerebrospinal fluid (CSF) drainage is a commonly used therapeutic technique in neurosurgery, includes external ventricular drainage (EVD) and lumbar cistern drainage (LD). It primarily involves the continuous drainage of CSF from the ventricles or lumbar cistern through a closed system to the outside of the body, aiming to release bloody or infected CSF. Additionally, it can be utilized for monitoring and controlling intracranial pressure, as well as for drug injection through the drainage tube. External CSF drainage is suitable for conditions such as cerebral hemorrhage accompanied by acute hydrocephalus, subarachnoid hemorrhage, intracranial hypertension, and intracranial infection. However, both drainage methods have contraindications. For instance, EVD is relatively contraindicated in patients with coagulation disorders and puncture site infections, while LD is contraindicated in patients with acute brain herniation, severe increase in intracranial pressure, lumbar deformity or bone destruction, severe systemic infection, high cervical spinal cord space-occupying lesions, and incomplete obstruction of the CSF circulation pathway. When implementing these drainage techniques, it is crucial to comprehensively evaluate the indications and contraindications based on the patient's specific condition and disease progression, to ensure the safety and effectiveness of treatment. Perioperative management of cerebrospinal fluid external drainage is crucial for successful treatment, encompassing the selection of drainage tubes, adjustment of drainage volume, removal of drainage tubes, and management of complications. Although the technique of cerebrospinal fluid external drainage has a low technical threshold and can be performed by hospitals at all levels, there is no consensus on issues related to drainage tube management. Therefore, the Neurosurgery Branch of the Chinese Medical Association and the Chinese Neurosurgery Critical Care Management Collaboration Group organized experts in the field of neurosurgery critical care to rewrite the 2018 "Expert Consensus on Cerebrospinal Fluid External Drainage Management in Neurosurgery Critical Patients" based on evidence-based medicine evidence combined with expert opinions, and formulated the "Expert Consensus on Cerebrospinal Fluid External Drainage Management in Neurosurgery Critical Patients (2024)". |
最新注册
