微创穿刺治疗高血压脑出血术后颅内感染的高危因素及感染后防治  

Risk factors of intracranial infections after drilling drainage treatment of hypertensive intracerebral hemorrhage and preventive countermeasures

作　　者：阿晓军 郝学红[2] 阮琳 蔡钧 李秀娟 李盛洲 

机构地区：[1]宁波市鄞州第二医院神经外科,浙江宁波315100 [2]青海省人民医院神经外科,青海西宁810007 [3]宁波市镇海龙赛医院神经外科,浙江宁波315200 [4]宁波市第七人民医院手术室,浙江宁波315202

出　　处：《中华医院感染学杂志》2013年第7期1560-1561,共2页Chinese Journal of Nosocomiology

摘　　要：目的分析微创穿刺治疗高血压脑出血术后颅内感染的高危因素及感染后防治,以控制颅内感染。方法收集2004年1月-2012年6月鄞州第二医院及青海省人民医院共457例高血压脑出血微创穿刺术后,32例颅内感染后临床资料进行回顾性分析,其中2006年后15例患者加用腰大池持续引流并鞘内注射术为观察组,另17例患者常规静脉抗菌药物治疗为对照组。结果 32例颅内感染患者中,30例治愈,2例后期转他院治疗;患者头部引流管放置时间>7d、术后并发肺部感染、水盐电解质失衡、高血糖成为术后颅内感染的危险因素(P<0.05);而发生颅内感染后及时采用腰大池持续引流鞘内注射可以取得较好的治疗效果:1周后除蛋白含量外体温、脑脊液压力、白细胞个数、含糖量、氯化物均明显改善(P<0.05)。结论术后尽早拔除颅内引流管;及时控制肺部感染和纠正水盐电解质可能减少颅内感染,及早应用腰大池引流术并鞘内万古霉素的应用是治疗颅内感染的首选。OBJECTIVE Analyze the intracranial infection risk factors of drilling drainage treatment of hypertensive intracerebral hemorrhage, and the treatment after intracranial infection. METHODS From Nov 2004 to Jun 2012, a total of 475 patients who underwent hypertensive intracerebral hemorrhage drilling puncture in the 2nd Hospital in Yinzhou District and the Qinghai Provincial People＇s Hospital were collected, and the clinical data of the 32 cases with the intracranial infections were retrospectively analyzed. Totally 15 cases who received the lumbar cistern puncture subarachnoid catheter continuous drainage were set as the observation group, and the rest of 17 cases who received the routine intravenous antibiotics treatment were set as the control group. RESULTS Of totally 32 cases of patients with intraeranial infections, 30 cases were cured, 2 cases were transferred to other hospital. The head drainage tube placed more than seven days, the water and electrolyte disorders, postoperative eomplica tion of pulmonary infections, and diabetes were the risk factors for postoperative intracranial infections （P〈0. 05）. The timely lumbar continuous intrathecal injection could achieve a better therapeutic effect; after the treat- ment for one week, the body temperature, the pressure of cerebrospinal fluid, white blood cells counts, and the content of glucose and chlorides were all significantly improved （P〈 0. 05）. CONCLUSION To withdraw the drainage tube in a earlier stage, control the pulmonary infections, and correct water and salt electrolyte may reduce the incidence of the intracranial infections. It is an preferred way to treat the intracranial infections to apply the lumbar drainage combined with intrathecal vancomycin in a timely manner .

关 键 词：高血压脑出血微创穿刺术 颅内感染 鞘内注射 

分 类 号：R181.32[医药卫生—流行病学]