颅后窝手术后感染原因分析及治疗

Causes and treatments of operative intracranial infections after posterior fossa craniotomy

目的对颅后窝术后感染原因分析,为减少颅后窝手术后感染以及提高疗效提供一定的借鉴。方法对发生颅后窝术后颅内感染28例进行细菌培养,并运用敏感抗生素加腰穿置管持续脑脊液引流,部分病例进行小剂量抗生素鞘内注射。结果感染得到有效控制,患者痊愈者27例,占96.4%。1例患者因感染未能控制,最终全身衰竭死亡。结论颅后窝手术因有较多易致感染因素,较其他开颅手术更易导致术后感染。手术中严格无菌操作,缩短手术时间,减少明胶海绵、止血纱以及人工植入物的放置,严密缝合伤口,减少局部积液及脑脊液漏的发生等能减少术后感染的发生。正确应用抗生素,腰穿置管引流、鞘内注射抗生素等对控制颅内感染效果较好。

Objective To analyze the causes of intracranial infections after posterior fossa craniotomy in order to reduce the infection rate and increase the therapeutic effect.Methods Twenty-eight patients with intracranial infections after posterior fossa craniotomy were retrospectively analyzed.According to the results of culture and drug sensitivity tests,all the patients were treated with high dosage antibiotics and lumbar puncture drainage.Some patients were also received intrathecal injection.Results The intracranial infection was effectively controlled.A total of 27 cases（96.4%） were cured,except of one dead case because of systemic infection and multiple organ failure.Conclusion Compared with other craniotomy,the posterior fossa craniotomy is more subject to intracranial infections.The surgical interventions,including strict aseptic operation,shortening of operation time,decrease of intracranial application of foreign matters,such as gelfoam,hemostatic gauze and artificial implants,sewing a wound tightly,decrease of subcutaneous hydrops and cerebral spinal fluid leak can reduce the possibilities of intracranial infections.Appropriate antibiotics selection,lumbar puncture drainage and intrathecal injection of antibiotics can cure the intracranial infections effectively.