脑出血患者微创引流术后颅内感染的临床分析  

Clinical efficacy of treatments for intracranial infections following minimally invasive drainage in 72 patients with intracerebral hemorrhage

作　　者：赵修敏[1] 周蕾[1] 吕涌涛 孙先义[1] 

机构地区：[1]山东省交通医院神经内科,山东济南250031

出　　处：《中华医院感染学杂志》2014年第19期4841-4843,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(2012GSF11806);山东省医药卫生科技基金资助项目(2011HD009)

摘　　要：目的探讨不同抗菌药物给药途径治疗脑出血患者微创钻颅置管外引流术后颅内感染的临床疗效。方法选择2009年1月-2013年6月72例脑出血行微创钻颅置管外引流术后颅内感染患者为研究对象,将36例行全身给药+腰穿后鞘内注射为A组,25例行全身给药+腰大池引流+鞘内注射为B组,11例行全身给药+脑脊液生理盐水置换为C组,比较3组患者治疗前后脑脊液常规指标差异,治疗期间不同时点脑脊液中的药物浓度以及患者的临床效果。结果 3组患者治疗后颅内压、脑脊液各项指标平均值恢复正常,颅内压值从高到低依次为C、A、B组,差异有统计学意义(F=12.341,P<0.05),C组氯化钠含量较A、B两组低,差异有统计学意义(F=4.621,P<0.05);B组患者治疗后不同时点脑脊液中药物浓度均为最高,C组明显低于A、B两组,差异有统计学意义(P<0.05);3组患者各项指标恢复时间中B组时间最短,C组最长,差异有统计学意义(P<0.05);3组均无明显不良反应发生。结论鞘内抗菌药物注射结合全身抗感染治疗能有效治疗颅内感染,其中腰大池置管引流比多次腰穿更能保证脑脊液中药物浓度,缩短治疗时间。OBJECTIVE To investigate the clinical efficacy of different antibiotic delivery routes for intracranial infections following minimally invasive cranial drill for external drainage in patients with intracerebral hemorrhage.METHODS Totally 72 patients with intracranial infections following minimally invasive cranial drill for external drainage were respectively studied,including 36 patients undergoing systemic antibiotic administration ＋intrathecal injection after lumbar puncture（group A）,25 patients undergoing systemic antibiotic administration＋lumbar drainage＋intrathecal injection（group B）,and 11 patients undergoing systemic antibiotic administration＋cerebrospinal fluid replacement with saline（group C）.The conventional indicators of cerebrospinal fluid were compared among three groups before and after treatment,the drug concentrations in cerebrospinal fluid were observed at different time points after treatment and the clinical efficacy were also compared.RESULTS The mean level of cerebrospinal fluid indicators returned to normal in three groups after treatment.The mean intracranial pressure value showed a decreasing trend from high to low in the order of group C,group A,and group B,with significant difference（F=12.341,P〈0.05）.The sodium content in group C was lower than that in group A and B,with significant difference（F=4.621,P〈0.05）.The drug concentration in cerebrospinal fluid in group B at different time points after treatment were the highest among the three groups,and the drug concentration in group C was significantly lower compared to groups A and B（P〈0.05）.The mean recovery time of each indicator in group B was the shortest among the three groups and was the longest in group C（P〈0.05）.CONCLUSION Intrathecal injection combined with systemic antibiotic anti-infective therapy is effective in treating intracranial infections,and lumbar drainage can guarantee drug concentration of cerebrospinal fluid and shorten treatment time compared to multiple lumbar punctures.

关 键 词：脑出血 微创钻颅置管外引流术 颅内感染 鞘内注射 

分 类 号：R619.3[医药卫生—外科学]