摘要
目的 探讨抗生素联合分流泵脑室端外置治疗脑积水分流术后顽固性感染的临床效果.方法 选取本院2010年1月至2015年1月收治入院的1652例脑积水分流手术病例中100例术后感染患者,病原菌主要为凝固酶阴性葡萄球菌,其次为金黄色葡萄球菌及革兰氏阴性菌.其中27例患者最初至少静脉使用3天抗生素,但脑脊液培养仍为阳性.在更换分流管之前,分流泵脑室端外置后即予以大剂量抗生素脑室内注射,持续时间平均10d （4～ 20d）.结果 本研究100例患者中,24 h引流量230 ～ 425ml,平均（335.50±59.82） ml,首次置管至施行永久性分流术的时间为41～69 d,平均（66.0±6.9）d.所有患者开始脑室内注入抗生素及脑室端分流管外置后第1、2、3天及＞3d者脑脊液培养阴性比例为34/100、42/100、69/100、100/100;随访6个月GOS评定：中残13例,重残9例,植物状态3例;无复发及患者死亡.结论 抗生素联合分流泵脑室端外置治疗脑积水分流术后顽固性感染治疗间期较短,能够使患者脑脊液培养结果迅速转为阴性,且复发率低,无一例死亡.
Objective To investigate the clinical effect of antibiotics combined with shunt pump with ventricle end outside for refractory infection after shunt surgery for hydrocephalus.Methods 100 patients infected after the surgery were selected from the 1652 patients undergoing shunt surgery for hydrocephalus at our hospital from January,2010 to January,2015.The main pathogenic bacteria were coagulase negative staphylococci （number 1）,staphylococcus aureus （number 2）,and gram negative bacteria （number 3）.Among which,27 patients were initially treated with antibiotics at least for 3 days,but CSF culture was still positive.Before replacing the shunt tube and after placing shunt pump with ventricle end outside,a large dose of antibiotics was injected into ventricle for average 10 d （4-20 d）.Results The 24 h drainage volume was 230-425 ml,with an average of（335.50 ＋ 59.82） ml.The time from first tube-placing to permanent shunt was 41-69 days,with an average of （66.0 ＋ 6.9） days.1,2,3,and ＞ 3 days after antibiotics was injected into the ventricle and shunt pump with ventricle end outside was placed in all the patients the cerebrospinal fluid culture negative proportion was 34/100,42 / 100,69 / 100,and 100 / 100,respectively.After 6 months＇ follow-up,GOS evaluation showed that 13 cases were disability,9 severe disability,and 3 in vegetative state.No patient died.Conclusions Antibiotics combined with shunt pump with ventricle end outside for refractory infection after shunt surgery for hydrocephalus has short treatment duration,can quickly make cerebrospinal fluid culture negative,has a low recurrence rate,causes no deaths.
出处
《国际医药卫生导报》
2015年第23期3455-3457,共3页
International Medicine and Health Guidance News
关键词
抗生素
脑积水
脑室-腹腔分流
顽固性感染
治疗
Antibiotics
Hydrocephalus
Ventricular-enterocoelia shunt
Refractory infections
Treatment
