后颅窝开颅术后颅内感染的预防及治疗

Prevention and cure of intracranial infections following posterior fossa craniotomy

目的 针对后颅窝开颅术后颅内感染原因进行防治研究,为减少后颅窝开颅术后感染提供借鉴.方法 对28例后颅窝开颅术后颅内感染患者行腰椎穿刺检查,并行细菌培养＋药敏试验.运用敏感抗生素加腰大池外引流,并给予小剂量抗生素鞘内注射.结果 28例患者行腰椎穿刺术,可见脑脊液压力均增高,脑脊液细菌培养阳性17例,阴性11例.治疗后27例患者感染得到有效控制而治愈,占96.4%.1例死于全身衰竭.结论 手术中严格无菌操作,缩短手术时间,减少明胶海绵、止血纱布以及人工材料的放置,减少局部积液及脑脊液漏的发生等是预防术后感染的有效方法.正确应用抗生素,腰椎穿刺置管引流、鞘内注射抗生素等对控制颅内感染效果较好.

Objective For decreasing the infected rate,the prevention and cure methods of intracranial infections following posterior fossa craniotomy were study. Methods Twenty-eight patients with the intracranial infections following posterior fossa craniotomy were examined by lumbar puncture,and analyzed cerebrospinal fluid with routine examination and reference to the bacteriological data and drug sensitive tests. All the patients were treated with high dosage sensitive antibiotics, and draining continually the infected cerebrospinal fluid by lumbar puncture catheterization and injected small dosages of antibiotics into intraspinal for most cases. Results Twenty-eight patients had intracranial hypertension by lumbar puncture examination, outcome of cerebrospinal fluid culture indicated that 17 cases had bacteria growth and 11 cases had no bacteria. The intracranial infection was controlled effectively,and 96.4%（27 cases） were cured, 1 case dead of systemic failure. Conclusions Strict aseptic techniques,reduce operative time,decrease intracranial place of foreign matters, such as gelfoam, hemostatic gauze and artificial implants, could reduce the possibilities of intracranial infections. Appropriate antibiotics selection,lumbar puncture catheterization and intraspinal administration of antibiotics can cure intracranial infections effectively.