腰蛛网膜下腔持续引流治疗术后颅内感染的研究  

Continuous drainage from lumbar subarachnoid space for the treatment of postoperative intracranial infection

作　　者：叶志其 刘慧[2] 杨建雄 冯文峰[3] 

机构地区：[1]河源市人民医院神经外科,广东河源517000 [2]山东省立医院脊柱外科,山东济南250021 [3]南方医科大学附属南方医院神经外科,广东广州510515

出　　处：《中国微侵袭神经外科杂志》2006年第5期204-205,共2页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的探讨腰大池穿刺持续引流对于颅脑术后颅内感染的治疗作用及适应证。方法将120例颅脑术后颅内感染病例分为两组:A组60例,采用腰大池持续引流并椎管内注射抗生素治疗,其中A1组30例,A2组30例;B组60例,每天行2次腰椎穿刺术并椎管内注射抗生素,但不持续引留,其中B1组30例,B2组30例;A1、B1组脑脊液白细胞数为500×106～10000×106/L,A2、B2组脑脊液白细胞数为20×106～500×106/L。结果在感染控制平均时间、临床症状改善时间和感染控制病例数方面,A1与B1组存在统计学差异(P<0.05),A2与B2组无统计学差异(P>0.05)。结论对术后脑脊液白细胞数在500×106/L以上的颅内感染,腰大池持续引流作用显著,值得临床推广;但对脑脊液白细胞数在500×106/L以下的颅内感染,每天仅需行2次腰椎穿刺术并椎管内注射抗生素即可,无需采用腰大池持续引留。Objective To study the therapeutical effects and indication of continuous drainage from the lumbar subarachnoid space for the treatment of postoperative intracranial infection. Methods One hundred and twenty patients with postoperative intracranial infection were randomly divided into 2 groups. Group A, consisting of 60 patients, were given continuous drainage from lumbar subarachnoid space and injected antibiotic twice per day through vertebral canal. Group B patients were given lumbar ptmcture and injected antibiotic through vertebral canal twice per day without continuous drainage. Groups A and B were randomly divided into 2 subgroups, namely groups A 1 and A2, groups BI and B2, 30 patients each. The leucocyte count ofcerehrospinal fluid was 500×10^6-10 000×10^6/L in groups AI and BI, and 20×10^6-500×10^6/L in groups A2 and B2. Results The average time of infection control, time of clinical amelioration and case number of infection control were studied comparatively. Group AI patients were significantly better than group BI （P〈0.05）. However, there was no significant difference between group A2 and group B2 （P〉0.05）. Conclusion Continuous drainage from lumbar subarachnoid space showed significant effectiveness for intracranial infection in the patients whose leucocyte count of cerebrospinal fluid were above 500×10^6/L. But, for the patients whose leucocyte count of cerehrospinal fluid was below 500×10^6/L, only lumbar puncture and antibiotic injection through vertebral canal twice per day were needed without continuous drainage.

关 键 词：引流术 蛛网膜下腔 手术后并发症 白细胞增多 抗菌药 

分 类 号：R651[医药卫生—外科学]