脑室-腹腔分流术后颅内感染的诊治(附9例报告)  

Diagnosis and Treatment of Intracranial Infection after Ventriculoperitoneal Shunt in 9 Patients with Hydrocephalus

作　　者：吕健[1] 巩守平[1] 崔刚[1] 周乐[1] 屈建强[1] 杨庆余[1] 

机构地区：[1]西安交通大学医学院第二附属医院神经外科,陕西西安710004

出　　处：《中国临床神经外科杂志》2007年第8期463-465,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨脑室-腹腔分流术(VPS)后颅内感染的处理原则。方法9例VPS后颅内感染病人中,7例拔除分流材料,4例行脑室外引流术,1例脑室内植入Ommaya囊,2例择期再次行VPS;根据脑脊液细菌培养和药敏试验结果,静脉联合鞘内或脑室内应用敏感抗生素。结果7例完全治愈,2例因经济原因放弃治疗,治愈率为77.8%(7/9)。结论①早期诊断、及时去除分流材料、合理应用抗生素是治疗VPS后颅内感染的基本原则;②与腹部手术相关的逆行性VPS后颅内感染值得重视;③严格的无菌术是其预防的根本。Objective To explore the strategy of diagnosis and treatment of shunt-related intracranial infection after ventriculo- peritoneal shunt （VPS） in the patients with hydrocephalus. Methods The clinical data of 9 patients with intracranial infection of 114 patients with hydrocephalus undergoing VPS were analysed reteospectively. The occurrence rate of the intracranial infection after VPS was 7.9%. The shunt materials were removed in 7 patiemts with intracranial infection. The lateral ventricular drainage was performed in 4 cases. An Ommaya reservoir was implanted in 1 case. VPS was repeated in 2 cases. Antibiotics were applied intravenously and intrathecally or intraventricularly according to the bacterial culture of cerebrospinal fluid and the tests of bacterial sensitivities to antibiotics. Results Of 9 patients with intracranial infection, 7 were cured and 2 gave up treatment because of the economic factor. The curative rate was 77.8% （7/9）. Conclusions The protocol including early diagnosis, removal of the shunt materials and proper antibiotics is the effective way to treat the intracranial infection after VPS. The ascending intracranial infection after laparotomy should be paid attention to. Strict aseptic and antiseptic surgical principle is the key to prevent the intracranial infection after VPS.

关 键 词：颅内感染 脑室-腹腔分流术 脑积水 治疗 预防 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R619.3[医药卫生—临床医学]