脑出血脑室置管引流术后继发颅内感染的临床研究  

Clinical research of secondary intracranial infection after ventricular drainage in cerebral hemorrhage

作　　者：林一民[1] 王广[2] 

机构地区：[1]重庆市肿瘤医院检验科,重庆400021 [2]重庆市中医院(重庆市中医研究院)神经外科,重庆400021

出　　处：《中国实用神经疾病杂志》2017年第20期63-67,共5页Chinese Journal of Practical Nervous Diseases

基　　金：重庆市中医院(重庆市中医研究院)院内培育基金资助项目(编号:2014-2-22);第三军医大学创伤;烧伤与复合伤国家重点实验室开放基金资助项目(编号:SKLK201505)

摘　　要：目的探讨神经外科脑出血脑室置管引流术后继发颅内感染的发生情况。方法试验分研究对照组,颅内感染病例组,每组38例。颅内感染病例组(疑诊颅内感染后24~48h)及研究对照组收集脑脊液及静脉血,集中检测C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)及一氧化氮(NO)含量,留取脑脊液行细菌培养及药敏鉴定。结果脑室置管引流时间1~7d,颅内感染发生率3.40%;脑室置管引流时间7~14d,颅内感染发生率11.06%;脑室置管引流时间14d以上,颅内感染发生率83.33%。脑室引流患者革兰阳性细菌感染发生率42.11%,革兰阴性细菌感染发生率55.26%,真菌感染发生率2.63%。金黄色葡萄球菌感染发生率31.58%。颅内感染病例组血清及脑脊液CRP、PCT、TNF-α、NO含量均明显高于研究对照组(P<0.05)。结论随着脑室置管引流时间的延长,颅内感染发生率逐渐增高,脑室引流患者颅内感染的病原菌以革兰阴性、革兰阳性细菌最为常见;同时监测血清与脑脊液中CRP、PCT、TNF-α及NO含量,有助于脑室引流术后继发颅内感染的早诊断,为早期治疗及合理应用抗生素提供依据。Objective To explore the incidence of secondary intracranial infection after intraventricular drainage in cerebral hemorrhage. Methods Subjects enrolled in this experimental study were divided into control group and intracranial infection group, 38 cases in each group. The cerebrospinal fluid and venous blood of the two groups （suspected of intracranial infection after 24-48h）were collected to detect C-reactive protein （CRP）,procalcitonin （PCT）,tumor necrosis factor-α （TNF-α） and nitric oxide （NO） content. Cerebrospinal fluid was collected for bacterial culture and drug sensitive identification. Results Ventricular drainage duration with 1-7 days, the incidence of intracranial infection was 3.40%; intraventricular drainage duration with 7-14 days,intracranial infection rate was 11.06%;ventricular drainage duration with more than 14 days, intracranial infection rate was 83.33G. In the patients treated with intraventricular drainage, the incidence of gram positive bacterial infection was 42.11%, the incidence of gram negative bacterial infection was about 55.26G, the incidence rate of fungal infection was about 2.63%, and the incidence of Staphylococcus aureus infection was 31.58%. The contents of CRP, PCT, TNF-α and NO in serum and CSF of intracranial infection group were significantly higher than those in control group （P〈0.05）. Conclusion With the prolongation of ventricular drainage time, the incidence of intracranial infection increased accordingly. Patients treated with ventricular drainage are mostly infected by gram negative and gram positive bacteria. Monitoring CRP, PCT, TNF-α and NO content in serum and cerebro-spinal fluid can help to diagnose secondary intracranial infection after ventricular drainage and provide the basis for early treatment and reasonable application of antibiotics.

关 键 词：脑出血 脑室引流 颅内感染 脑脊液 临床研究 

分 类 号：R743.34[医药卫生—神经病学与精神病学]