腰穿与腰大池引流结合鞘内注射治疗开颅术后颅内感染的临床效果比较  

Clinical effects of lumbar puncture and lumbar drainage combined with intrathecal injection on treatment of intracranial infections after craniotomy:a comparative study

作　　者：章国军[1] 何民[1] 杜杭根[1] 殷利春[1] 田勇[1] 王承[1] 郝必烈[1] 陈立[1] 李宏宇[1] 

机构地区：[1]浙江中医药大学附属第二医院神经外科,浙江杭州310005

出　　处：《中华医院感染学杂志》2014年第2期444-446,共3页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科技计划基金项目(2011ZA037)

摘　　要：目的比较分别应用腰椎穿刺与腰大池引流结合鞘内注射万古霉素治疗开颅术后颅内感染的效果及治疗有效时间和不良反应的发生情况。方法选取2004年1月-2013年4月开颅术后发生颅内感染患者共34例,将采用腰椎穿刺鞘内注射治疗的患者作为A组,共19例,将采用腰大池引流鞘内注射治疗颅内感染的患者作为B组,共15例,所有患者均按照颅内感染常规治疗进行基础治疗,A组每天行腰椎穿刺放出感染脑脊液50ml,完成后鞘内注射含50mg万古霉素的生理盐水5ml;B组向引流管内注入含50mg万古霉素的生理盐水5ml,夹闭引流管,待2h后打开引流管进行引流,拔管后若感染未被完全控制可视患者具体情况行腰椎穿刺鞘内注射万古霉素。结果 A组中金黄色葡萄球菌感染10例、表皮葡萄球菌感染4例、铜绿假单胞菌感染3例、变形菌属感染2例,B组中金黄色葡萄球菌感染9例、表皮葡萄球菌感染5例、铜绿假单胞菌感染1例;两种方法治疗开颅术后颅内感染均有效,但A组治愈16例,治愈率为84.21%,B组治愈14例,治愈率为93.33%,B组的治愈率明显高于A组,差异有统计学意义(P<0.05);A组平均有效治疗时间(8.4±1.3)d,B组(6.3±1.0)d,B组治疗时间明显短于A组(P<0.05);诉腰痛明显A组中有13例,占68.42%,B组有2例,占13.33%,B组腰痛比例明显低于A组,差异有统计学意义(P<0.05)。结论采用腰大池引流结合鞘内注射万古霉素治疗开颅术后颅内感染操作简便,不良反应少,效果确切,临床应用价值有待进一步观察。OBJECTIVE To compare the effect of lumbar puncture and lumbar drainage combined with intrathecal vancomycin injection on the treatment of intracranial inf6ction after craniotomy, effective treatment time, and inci- dence of adverse reactions. METHODS A total of 34 cases of patients had intracranial infection after craniotomy from Jan. 2004 to Apr. 2013 were selected. Lumbar puncture and lumbar drainage treatment was given to the 19 patients in A group, and lumbar puncture and lumbar drainage combined with intrathecal vancomycin injection treatment was given to the 15 patients in B group. All patients got conventional treatment of intracranial infection. Every day, 50 ml infected cerebrospinal fluid was released by lumbar puncture to the patients in A group, followed by intrathecal injection of 5 ml saline with 50 mg vancomycin. In B group, 5 ml saline with 50 mg vancomycin was injected through drainage tube and then clamped the tube for 2 hours before open it to drainage, and if the infection was not totally controlled after the tube disconnected, vancomycin then could be injected by lumbar puncture when necessary. RESULTS A total of 10 cases of Staphylococcus aureus infections, 4 cases of Staphylococcus epidermi- dis infections, 3 cases of Pseudomonas aeruginosa infections and 2 cases of Proteus infections were detected in Agroup. A total of 9 cases of Staphylococcus aureus infections, 5 cases of Staphylococcus epidermidis infections and 1 cases of Pseudomonas aeruginosa infection were detected in B group. Both of the two methods were effective for intracranial infection after craniotomy, while the cure rate in A group was 84.21% （16 cases were cured）, and 93.33% in B group （14 cases were cured）, and the rate in B group was obviously higher than that in A group （P 〈0.05）. The average effective treatment time in A group was （8.4 ±1. 3） days, while （6.3 ±1.0） days in B group, and the time in B group was much shorter than A group （P〈0.05）. There were 13 cases in A group with obvious pa

关 键 词：腰椎穿刺 腰大池引流 鞘内注射 颅内感染 

分 类 号：R181.32[医药卫生—流行病学]