低浓度三氯异氰尿酸在颅内脓肿治疗中的临床研究

Low concentration of trichloroisocyanuric acid for intracranial abscess

目的观察颅内脓肿应用三氯异氰尿酸冲洗的疗效,探索颅内感染的新疗法。方法 61例颅内脓肿按单盲随机分为治疗组(n=26)及对照组(n=35)。对照组仅给予常规庆大霉素冲洗治疗,治疗组采用三氯异氰尿酸冲洗脓腔或术野局部浸泡15min。术后以临床症状及神经影像学检查结果判断脓肿治疗效果,并进行随访。结果治疗组术后平均住院天数13d;单次冲洗后完全治愈24例,多次冲洗后治愈2例。对照组术后平均住院天数16d;完全治愈15例,脑梗死2例,不同程度偏瘫和癫疒间11例,1个月内复发5例,死亡2例。治疗组与对照组比较,差异有统计学意义(P<0.01),且平均住院时间短,后遗症发生率较低。结论对于内科治疗无效的颅内脓肿,在脓肿切开、穿刺抽吸等外科治疗的同时,采用三氯异氰尿酸冲洗,可以避免脓肿切除导致的脑功能损害及感染扩散,达到完全控制感染及生物学治愈标准。

Objective To observe the therapeutic effect of trichloroisocyanuric acid washing on intracranial abscess for exploration into a new therapy for intracranial infection. Methods Sixty-one patients with intracranial abscess were randomly divided into treatment group （n=26） and control group （n=35）. The control group was given the conventional treatment with gentamicin,while the treatment group was given abscess cavity washing with trichloroisocyanuric acid or local infiltration for 15 minutes. The therapeutic effect was determined by clinical symptom and MRI examination with the patients being followed up. Results In the treatment group,24 of 26 patients were cured after the first washing,the rest 2 required repeated procedures,and the average hospitalization time was 13 days. In the control group,15 of 35 patients were cured,2 complicated with cerebral infarction after operation,11 with hemiplegia and epilepsy,5 recurred in a month,2 died,and the average hospitalization time was 16 days. Compared with the control group,the therapeutic effect was more significantly improved the treatment group （P0.01）.The average hospitalization time was shorter with decreased incidence of sequelae. Conclusions For intracranial abscess of failed medical therapy,surgical treatment such as incision and aspiration with trichloroisocyanuric acid washing could avoid brain impairment and infection diffusion caused byresection ofabscess and achieve standard infection control and biological cure.