严重颅内感染的综合诊疗策略  

Combined therapeutic strategies for severe intracranial infection

作　　者：胡锦 魏俊吉[2] WANG Qiang;WANG Han- dong;PAN Hao(Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China)

机构地区：[1]复旦大学附属华山医院神经外科 [2]中国医学科学院北京协和医院神经外科

出　　处：《临床神经外科杂志》2018年第3期193-201,共9页Journal of Clinical Neurosurgery

基　　金：南京大学医学院附属金陵医院院管课题（2017006）

摘　　要：目的探讨对重度颅内感染,尤其是脑室炎有效的综合诊疗策略。方法回顾性统计分析211例颅内感染患者的临床资料,其中28例为脑室炎患者。对4例常规抗感染治疗无效的重度颅内感染患者行双侧侧脑室额角穿刺置管,左-右侧脑室引流管抗生素持续对冲。脑室冲洗液清亮后,腰大池引流通畅者改为腰大池持续引流。非功能区脓肿灶予以手术切除后,再行脑室持续冲洗;脑室粘连、分隔患者行内镜下终板造瘘＋透明隔造瘘＋脉络丛烧灼术;有脑积水者行侧脑室-腹腔分流或内镜下第三脑室底造瘘术。结果 211例颅内感染患者的脑脊液培养的阳性率为13.3%;脑脊液培养阴性的颅内感染患者治愈率为92.9%,而脑脊液培养阳性颅内感染患者的治愈率仅为42.8%。28例脑室炎患者,脑脊液培养的阳性率为42.8%,总治愈率为67.8%,其中脑脊液培养阴性患者的治愈率为75%,培养阳性患者的治愈率为58.3%。本组4例重度颅内感染患者均治愈。脑室冲洗时间为7～47 d。随访3～9个月,患者的感染均未反复。结论对于重度颅内感染,尤其是脑室炎、脑室积脓患者,采用抗生素脑室持续冲洗,并联合脑室镜等方法的综合治疗是安全有效的。Objective To study the effective comprehensive therapeutic strategies for severe CNS infection,especially ventriculitis. Methods The clinical data of 211 CNS infection patients including 28 ventriculitis patients were analyzed retrospectively. Four cases of serious intracranial infection were treated by bilateral anterion horn of lateral ventricle catheterization,24 hours continuous flushing with natural saline containing antibiotics and drainage. If flushing fluid was clear,lumbar cistern drainage was used. If abscess was in non-functional area,it should be resected before lateral external ventricular drainage. When adhesion and partition in ventricle was formed,ventricularendoscopy surgery was needed. The ventriculo-peritoneal shunt or endoscopic third ventriculostomy was needed if hydrocephalus happened. Results Positive rate of CSF cultivation in211 CNS infection patients was 13. 3%. Curative rate of CNS infection patients with negative CSF cultivation was 92. 9% while that of CNS infection patients with positive CSF cultivation was42. 8%. Among 28 ventriculitis patients,positive rate of CSF cultivation was 42. 8% with total curative rate of 67. 8%. Curative rate of ventriculitis patients with negative CSF cultivation was 75%while that of ventriculitis patients with positive CSF cultivation was 58. 3%. These 4 patients were all cured. The time of external ventricle drainage（ EVD） were 7-47 days. Follow-up periods ranged from3 to 9 months showed all patients had no infection recurrence. Conclusion Bilateral EVD continuous flushing and drainage,combined with ventricularendoscope operation are effective treatments for severe intracranial infection,especially ventriculitis and pyocephalus.

关 键 词：重度颅内感染 双侧脑室穿刺 冲洗 

分 类 号：R651.1[医药卫生—外科学]