神经内镜辅助下多重耐药革兰阴性菌感染致化脓性脑室炎并脑室积脓治疗的临床研究  

Clinical study on the treatment of pyogenic ventriculitis and intraventricular pus caused by multi-drug resistant Gram negative bacteria infection assisted by neuroendoscopy

作　　者：常涛 史正华 郭清保 杨彦龙 李立宏 CHANG Tao;SHI Zheng-hua;GUO Qing-bao;YANG Yan-long;LI Li-hong(Tangdu Hospital of Air Force Military Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学唐都医院,陕西西安710038

出　　处：《临床医学研究与实践》2020年第8期1-3,共3页Clinical Research and Practice

基　　金：陕西省重点研发计划项目(No.2017ZDXM-SF-042)。

摘　　要：目的探讨神经内镜辅助下多重耐药革兰阴性菌感染致化脓性脑室炎并脑室积脓治疗的临床效果。方法回顾性分析我院14例多重耐药革兰阴性菌感染致化脓性脑室炎并脑室积脓患者的临床资料,观察患者脑脊液微生物培养结果、相关指标变化及治疗结果。结果脑脊液细菌培养鲍曼不动杆菌的检出率最高(42.86%)。患者内镜术后脑脊液细菌培养阴性(5.21±2.19)d,体温正常(7.71±1.98)d,连续3次脑脊液达标(13.21±3.40)d;脑室引流管留置时间(17.07±4.48)d,内镜术后抗生素使用时间(23.00±4.35)d。感染相关性死亡2例(14.29%),12例生存患者中继发脑积水11例(91.67%)。生存患者随访1年,GOS评分:4分3例,2分4例。结论采用神经内镜下脑室内脓肿清除联合敏感抗生素脑室内灌洗有利于多重耐药革兰阴性菌感染导致的化脓性脑室炎并脑室积脓的治疗。Objective To explore the clinical effect of treatment of pyogenic ventriculitis and intraventricular pus caused by multi-drug resistant Gram negative bacteria infection assisted by neuroendoscopy.Methods The clinical data of 14 patients with pyogenic ventriculitis and intraventricular pus caused by multi-drug resistant Gram negative bacteria infection were retrospectively analyzed.The results of cerebrospinal fluid microbial culture,the changes of related indexes and the treatment results were observed.Results The detection rate of Acinetobacter baumannii cultured in cerebrospinal fluid was the highest(42.86%).The average duration after neuroendoscopic surgery in cerebrospinal fluid bacteria culture negative,body temperature normal and cerebrospinal fluid examination normal for three consecutive times was(5.21±2.19),(7.71±1.98)and(13.21±3.40)days respectively.The duration of ventricular drainage retention was(17.07±4.48)days,antibiotic using time was(23.00±4.35)days after neuroendoscopic surgery.Infection-related death was found in 2 cases(14.29%).Among the 12 survivors,11(91.67%)developed secondary hydrocephalus.The survival patients were followed up for one year,GOS score:4 points in 3 cases,2 points in 4 cases.Conclusion It is beneficial for pyogenic ventriculitis and intraventricular pus caused by multi-drug resistant Gram negative bacteria infection patients to treat by neuroendoscopic removal of intraventricular pus combined with sensitive antibiotic intraventricular lavage.

关 键 词：神经内镜 化脓性脑室炎 多重耐药 革兰阴性菌 

分 类 号：R512.3[医药卫生—内科学]