腰大池引流联合经验用药治疗神经外科术后细菌培养阴性脑膜炎  

Therapy of the neurosurgical postoperative culture negative meningitis by using external lumbar drainage combined with empirical antibiotics treatment

作　　者：洪健[1] 吴剑涓[1] 陈步东[1] 姚鑫[1] 杨玉山[1] 

机构地区：[1]天津市环湖医院神经外科,300060

出　　处：《中华外科杂志》2016年第5期372-375,共4页Chinese Journal of Surgery

摘　　要：目的探讨腰大池引流联合经验用药治疗神经外科术后脑脊液细菌培养阴性脑膜炎的效果。方法回顾性分析天津市环湖医院神经外科2013年1月至2014年12月收治的符合纳人和排除标准的术后脑脊液细菌培养阴性脑膜炎患者的临床资料，共有80例患者入组，其中男性45例，女性35例，年龄9～72岁。根据采用的治疗方法将80例患者分为两组：经验用药组40例采用抗菌药物经静脉给药途径，联合治疗组40例在经验用药同时行腰大池持续引流术，脑脊液引流量控制在200～300ml／d，两组使用同一种抗菌药物时剂量、给药间隔等无差别。采用t检验、Wileoxon检验或）（。检验比较两组患者的抗菌药物使用情况及治疗效果。结果天津市环湖医院神经外科此时段内术后脑膜炎患者脑脊液细菌培养阴性率为62．9％（88／140）。经验用药组静脉抗菌药物平均使用疗程为（12．6±3．1）d，联合用药率40．0％（16／40），病死率15．0％（6／40）；联合治疗组分别为（5．3±1．2）d、10．0％（4／40）、7．5％（3／40）。经验用药组抗菌药物使用疗程（t=3．605，P=0．017）、联合用药率（x2=3．971，P=0．035）及病死率（x2=4．136，P=0．027）均高于联合治疗组。联合治疗组腰大池引流平均带管时间为（5．8±1．5）d，32例患者一次置管治愈，2例因堵管，3例因引流超过14d，行再次置管治愈。随访3个月无复发病例。结论腰大池引流联合经验用药治疗神经外科术后细菌培养阴性脑膜炎可以减少抗菌药物使用剂量和时间。Objective To evaluate the curative effect of external lumbar drainage combined with empirical antibiotics treatment on the postoperative culture negative meningitis. Methods The clinical data of eighty post-operative meningitis patients with eerebrospinal fluid culture negative were retrospectively analyzed according to inclusive and exclusive criteria from January 2013 to December 2014 in Department of Neurosurgery, Tianjin Huanhu Hospital. All patients were composed of 45 male cases and 35 female cases, aging from 9 to 72 years. All patients were divided into two groups according to receiving the different treatment： one group only receiving a intravenously empirical antibiotics treatment （n = 40） , another group receiving a combined therapy of external lumbar drainage and intravenously empirical antibiotics treatment （ n = 40）. The volume of drainage of eerebrospinal fluid （ CSF ） were set up from 200 to 300 ml per day. There was no difference in the dosage and interval of the same antibiotics between two groups. The antibiotics usage and therapeutic effect of two groups of patients were observed and analyzed by t-test, Wilcoxon rank test or X2 test. Results The rate of CSF bacterial culture negative was 62. 9% （88/140） in the same period. In group of empirical antibiotics treatment, the time of antibiotics treatment was （12. 6 ± 3.1 ） days, the rate of combined with other antibiotics treatment was 40. 0% （16/40） , the rate of mortality was 15.0% （6/40）. However, in group of external lumbar drainage combined with empirical antibiotics treatment, the 3 data were （5.3 ± 1.2） days, 10. 0% （4/40）, 7.5% （3/40）, respectively. The time of antibiotics of the group of empirical antibiotics was longer （t =3. 605, P =0. 017）, while the rate of combined antibiotics and the rate of mortality were lower （X2 = 3. 971, P =0. 035; X2 =4. 136, P = 0. 027, respectively）. The average drainage time was （ 5.8 ±1.5 ） days, 32 patients gained a complete healing only by their fi

关 键 词：脑膜炎 引流术 手术后并发症 

分 类 号：R651[医药卫生—外科学]