长程皮下通道脑室外引流技术在重型颅脑损伤术后泛耐药鲍曼不动杆菌颅内感染治疗中的应用研究  

Clinical effect of long-tunneled external ventricular drain in treatment of intracranial infec⁃tion with extensively drug-resistant Acinetobacter baumannii after surgery for severe traumat⁃ic brain injury

作　　者：毕长龙[1] 兰松[1] 罗湘颖[1] 刘劲芳[1] BI Chang-Long;LAN Song;LUO Xiang-Ying;LIU Jing-Fang(Department of Neurosurgery,Xiangya Hospital,Central South University,Changsha,Hunan 410078,China)

机构地区：[1]中南大学湘雅医院神经外科,湖南长沙410078

出　　处：《国际神经病学神经外科学杂志》2021年第1期4-8,共5页Journal of International Neurology and Neurosurgery

基　　金：湖南省自然科学基金(2011JJ5082)。

摘　　要：目的探讨长程皮下通道脑室外引流(LTEVD)技术在治疗重型颅脑损伤(TBI)术后泛耐药鲍曼不动杆菌(XDR-AB)颅内感染的临床效果。方法回顾性分析2014年1月1日-2018年12月31日中南大学湘雅医院收治的65例TBI开颅术后并发颅内感染患者的临床资料。其中,50例以短程皮下通道脑室外引流(STEVD)技术治疗为STEVD组,15例术后并发XDR-AB性颅内感染行LTEVD技术治疗为LTEVD组。所有患者均进行围手术期规范化管理,依据脑脊液细菌培养药敏结果选择敏感抗生素治疗,XDR-AB者同期予以脑室内多黏菌素给药。结果两组患者一般特征、脑积水发生率、新增感染率及病死率比较,差异均无统计学意义(P>0.05)。STEVD组脑室内置管时间为(10.7±5.3)d,中位数10.0 d。而LTEVD组脑室内留置导管时间为(31.7±9.2)d,中位数32.0 d。两组比较,差异有统计学意义(P <0.05)。结论 LTEVD技术可以安全地延长脑室外引流时间超过1个月,疗效好,适用于难治性颅内感染或颅内外顽固性积液需长时程(>4周)脑脊液引流患者。Objective To investigate the clinical effect of long-tunneled external ventricular drain(LTEVD)in the treatment of in⁃tracranial infection with extensively drug-resistant Acinetobacter baumannii(XDR-AB)after surgery for severe traumatic brain injury(TBI).Methods A retrospective analysis was performed for the clinical data of 65 patients with intracranial infection after cranioto⁃my for TBI who were admitted to Xiangya Hospital of Central South University from January 1,2014 to December 31,2018,among whom 50 patients received short-tunneled external ventricular drain(STEVD)(STEVD group)and 15 received LTEVD for intracrani⁃al infection with XDR-AB(LTEVD group).All patients received standardized management in the perioperative period,and antibiotics were administered based on the drug susceptibility results of cerebrospinal fluid bacterial culture;the patients with XDR-AB infection were given intraventricular polymyxin B.Results There were no significant differences between the two groups in general features,incidence rate of hydrocephalus,rate of new infections,and mortality rate(P>0.05).The STEVD group had a duration of intraventric⁃ular drainage tube placement of 10.7±5.3 d,with a median of 10.0 d,while the LTEVD group had a duration of 31.7±9.2 d,with a me⁃dian of 32.0 d;there was a significant difference in the duration between the two groups(P<0.05).Conclusions LTEVD can extend the duration of external ventricular drainage to more than 1 month with good safety and clinical effect,and therefore,it is suitable for patients requiring a long duration(>4 weeks)of cerebrospinal fluid drainage due to refractory intracranial infection or intracranial/ex⁃tracranial effusion.

关 键 词：脑室外引流 颅内感染 鲍曼不动杆菌 泛耐药 长通道 

分 类 号：R651.1[医药卫生—外科学]