脑出血患者微创术后引流导致颅内感染的临床分析  

Clinical analysis on intracranial infection induced by drainage after minimally invasive surgery in patients with cerebral hemorrhage

作　　者：张鹏 卢颖[2] 

机构地区：[1]郑州颐和医院神经外科,河南郑州450047 [2]新乡医学院护理学院,河南新乡453003

出　　处：《中华医院感染学杂志》2014年第23期5874-5876,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅重点基金资助项目(HW-2010B-019)

摘　　要：目的探讨脑出血微创术后引流导致颅内感染的临床诊断和治疗方法,提高临床对该类疾病的治疗水平。方法选取2011年3月-2013年4月脑出血颅内血肿微创清除术后引流患者2 462例,对其临床资料进行回顾性分析,分析导致颅内感染的危险因素;对颅内感染患者脑脊液行细菌培养并药敏试验,采用SPSS13.0软件进行统计分析。结果 2 462例患者共发生颅内感染146例,发生率为5.93%;发生颅内感染的患者中老年、糖尿病、意识障碍患者预防性应用抗菌药物、急诊手术、留置引流时间≥3d、且在引流过程中出现脑脊液漏和引流管污染者明显多于未发生感染者(P<0.05);革兰阳性菌对苯唑西林、红霉素、克林霉素、诺氟沙星、青霉素、庆大霉素和左氧氟沙星等耐药性普遍较高,均≥50.00%;而对万古霉素、米诺环素以及利奈唑胺的耐药性普遍较低;革兰阴性菌普遍对阿米卡星、头孢他啶、美罗培南以及亚胺培南的耐药性较低,均<35.00%。结论密切观察患者生命体征,当有感染征象时应通过影像学和实验室检查进行确诊;颅内感染病原菌较为复杂,早期可以根据经验用药,在治疗中根据药敏试验结果对治疗方案进行调整。OBJECTIVE To study the clinical diagnosis and treatment of intracranial infection induced by drainage after minimally invasive surgery so as to improve the level of clinical treatment of the disease .METHODS Totally 2462 patients who underwent drainage after the minimally invasive removal surgery for intracranial hematoma dur‐ing Mar .2011 to Apr .2013 were selected and clinical data of all the patients were reviewed ,the risk factors of in‐tracranial infection were analyzed .The cerebrospinal fluid of patients with intracranial infection was collected for bacterial culture and drug sensitive test .Data were statistically analyzed with the software SPSS 13 .0 .RESULTS Among the total of 2462 patients ,there were 146 cases of intracranial infection ,the incidence rate was 5 .93% . The number of patients who had middle or old age ,diabetes ,prophylactic use of antibiotics for disturbance of con‐sciousness ,emergency surgery ,indwelling drainage time of 3 days or longer ,cerebrospinal fluid leakage during the process of drainage and drainage tube pollution was significantly more in the infected patients than in the non‐infected patients （P〈0 .05） .Gram‐positive bacteria had generally high drug resistance to oxacillin ,erythromycin , clindamycin ,norfloxacin ,penicillin ,gentamicin and levofloxacin （all ≥50 .00% ） ,but generally low resistance to vancomycin ,minocycline ,and linezolid .Gram‐negative bacteria had low resistance to amikacin ,ceftazidime ,mer‐openem and imipenem （all 〈 35 .00% ） .CONCLUSION Patients should be closly observed for vital signs ,and should be diagnosed by imaging and laboratory examination when there are signs of infection .Pathogens for in‐tracranial infection are relatively complex ,empirical medication can be adopted during early treatment and the regi‐ment can be adjusted according to the results of drug sensitive test during the treatment .

关 键 词：脑出血 微创术 引流 颅内感染 

分 类 号：R619.3[医药卫生—外科学]