颅脑手术后颅内感染的诊断与治疗

Diagnosis and treatment of intracranial infection in patients undergoing craniotomy

目的探讨颅脑手术后继发颅内感染的危险因素和诊断及治疗方法。方法回顾性分析763例开颅手术中发生颅内感染的25例病例,总结分析颅内感染的危险因素和抗生素治疗方案。结果 25例颅内感染患者中,应用万古霉素+头孢他啶治疗9例,应用比例最高,是较好的治疗方案。幕下开颅手术后颅内感染率为8.7%,幕上开颅手术后的颅内感染率2.5%(P<0.05);显微手术的颅内感染率为6.2%,非显微手术的颅内感染率为2.2%(P<0.05);手术持续时间比较,将手术时间分为<3h、3～6h和>6h3个组,两两比较差异均有统计学意义(P<0.01或P<0.05);颅内引流管留置时间比较,将其分为<3d、3～7d、>7d3个组,两两比较差异均有统计学意义(P<0.01)。结论显微手术、幕下开颅手术、手术持续时间长、停留颅内引流管时间长是颅内感染的危险因素,颅内感染的经验性治疗仍然是重要的治疗手段,要结合抗生素的耐药状况选择合适的抗生素。

Objective To investigate the risk factors and treatment of intracranial infection in patients undergoing craniotomy.Methods 25 cases developed intracranial infection in 763 patients undergoing craniotomy were retrospective analysed.The risk factors of intracranial infection and its treatment were reviewed.Results 25 cases of patients with intracranial infection,vancomycin＋ceftazidime treatment in 9 patients,the highest proportion of applications,was a better treatment method.Infratentorial craniotomy for intracranial infection was 8.7%,after supratentorial craniotomy,intracranial infection rate 2.5% （P0.05）;Microsurgery of intracranial infection rate was 6.2%,non-microsurgery intracranial infection rate was 2.2% （P0.05）;Operation duration of comparison,the operative time was divided into 3h,3～6h and 6h 3 groups,there were significant differences in pairwise comparison （P0.01 or P0.05）;Intracranial drainage retention time comparison,divided into 3d,3～7d,7d 3 groups,there were significant differences in pairwise comparison （P0.01）.Conclusion Microsurgery and infratentorial craniotomy,duration of operation,prolonged ventricular catheterization are the risk factors of intracranial infection.Empirical treatment for postsurgical intracranial infection appears to be very important according to our study.Antibacterials should be chosen with regard to the bacteria-sensitivity test.