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- 2019
Chiari畸形Ⅰ型经神经内镜下后颅窝减压术后发热原因探讨及技术改进
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Abstract:
摘要：目的 探讨引起Chiari畸形Ⅰ型后颅窝减压术后患者发热的感染性因素和非感染性因素，同时提出相应的改进措施，以减少患者术后发热的发生率。方法 回顾性分析2018年3月-2019年3月就诊于西安交通大学第一附属医院的14例Chiari畸形Ⅰ型后颅窝减压术后患者的临床资料，并比较传统缝合技术组和硬膜-肌肉悬吊缝合组术后发热的发生率，以及住院时间和住院花费的差异。结果 在纳入研究的14例患者中，其中7例术中采用传统缝合技术，术后均出现术区的硬膜外积液和发热，而且3例被证实存在中枢神经系统感染，其余7例患者采用我们自研创新的硬膜-肌肉悬吊缝合法后，均未出现术后积液和发热。所有患者均经临床治愈出院，与传统缝合组相比较，缝合改进组的住院花费更少(P<0.05)，住院时间更短(P<0.05)。结论 非感染性因素，尤其是硬膜外积液可能是Chiari畸形Ⅰ型后颅窝减压术患者术后发热的主要原因，通过采用硬膜-肌肉悬吊缝合的方式可以降低该并发症。
ABSTRACT: Objective To investigate the infectious and non-infectious factors of postoperative fever in patients with type Ⅰ posterior fossa decompression of Chiari malformation and to explore corresponding surgical improvement measures to reduce postoperative fever. Methods We retrospectively analyzed the clinical data of 14 patients with Chiari malformation type Ⅰ posterior fossa decompression treated in The First Affiliated Hospital of Xi’an Jiaotong University during March 2018 and March 2019. We compared the incidence of postoperative fever and hospitalization duration and cost between the two groups. Results Among the 14 included patients, 7 of them were treated with the traditional suture technique, and all of them had postoperative epidural effusion and fever. Three of them were confirmed to have central nervous system infection. After application of our self-developed and innovative dural muscle suspension suture method on seven patients, no postoperative effusion and fever occurred. All the patients were cured and discharged from the hospital. Compared with the traditional suture group, the improved suture group had a lower hospitalization cost and shorter hospitalization time (P<0.050, P<0.050). Conclusion Non-infectious factors, especially epidural effusion, may be the main cause of postoperative fever in patients with Chiari malformation type I posterior fossa decompression, which can be minimized by dural muscle suspension suture
