脑肿瘤开颅术后脑膜炎的临床特征及腰大池持续引流的应用价值

The clinical manifestations and application of continuous lumbar subarachnoid drainage for brain tumor patients with postcraniotomy meningitis

目的探讨脑肿瘤术后脑膜炎的临床特征及腰大池持续引流的应用价值。方法对2004年1月至2009年11月间41例脑肿瘤术后脑膜炎病例临床资料进行回顾性分析。其中,无菌性脑膜炎28例,细菌性脑膜炎13例。结果两组间发热发生率、意识改变、发热开始时间、脑脊液常规及生化指标无显著性差异。无菌性脑膜炎治愈时间显著低于细菌性脑膜炎(P<0.05)。脑膜炎后选择腰大池置管持续引流较反复腰穿在治愈时间、治愈率无显著性差异(P>0.05)。结论脑肿瘤开颅术后脑膜炎无特异临床表现。无菌性脑膜炎治愈时间显著低于细菌性脑膜炎,但腰大池持续引流并不能降低脑肿瘤术后脑膜炎患者的治愈时间及提高治愈率。

Objective To determine the clinical manifestation of postcraniotomy meningitis （PCM）,and the efficacy of continuous lumbar subarachnoid drainage for patients with PCM.Methods The clinical data of 41 patients with brain tumor and complicated with PCM between January 2004 and November 2009 was collected and analyzed retrospectively.Of which,there were 28 cases with aseptic meningitis and 13 cases with bacterial meningitis.Results With respect to incidence of fever,consciousness disturbance,duration from operation to the onset of symptoms and the characteristics of the cerebrospinal fluid（CSF）,there were no significantly differences between two groups.Curative duration of aseptic group was significantly shorter than that of bacterial group （P0.05）.However,continuous lumbar subarachnoid drainage cannot significantly shorten the curative duration or decrease the mortality as compared to repeatedly conventional lumbar puncture （P0.05）.Conclusion There are no characteristic clinical features except for the proven positive bacteria culture in brain tumor patients of postcraniotomy meningitis.The curative duration of aseptic group was significantly shorter than that of bacterial group.However,continuous lumbar subarachnoid drainage cannot shorten the curative duration or decrease the mortality of patients with PCM,compared with the repeated lumbar puncture.