脑出血微创穿刺术后并发颅内感染的临床分析

Clinical Analysis of Intracranial Infection after Minimally Invasive Surgery for Cerebral Hemorrhage

目的探讨脑出血微创穿刺术后并发颅内感染的原因及防治措施。方法回顾性分析2004年7月-2011年1月神经内科收治的23例高血压脑出血微创穿刺术后并发颅内感染患者的临床资料。结果穿刺术后并发颅内感染23例。其中脑实质穿刺引流3例,占13.04%;脑实质出血破入脑室7例,占30.43%;侧脑室穿刺引流13例,占56.52%;脑脊液漏5例,占21.73%;引流管污染3例,占13.04%;年龄>65岁8例,占34.78%;糖尿病9例,占39.13%;无菌操作不规范8例,占34.78%;置管时间长5例,占21.73%。结论高血压脑出血微创穿刺术后,尤其是侧脑室或出血破入脑室穿刺后更易并发颅内感染,应加强无菌观念,注意无菌操作,减少或避免颅内感染。选择易透过血脑屏障的抗生素联合鞘内注射有明确疗效,可有效地提高治愈率,降低病死率。

Objective To investigate the causes and prevention measures of intracranial infection after minimally invasive surgery for cerebral hemorrhage.Methods Retrospectively analyze the clinical data of 23 patients admitted to our department from July 2004 to Jan.2011 with hypertensive intracerebral hemorrhage underwent minimally invasive surgery.Results There were 23 cases of intracranial infection after minimally invasive surgery,in which 3 cases underwent drain from the brain parenchyma,accounting for 13.04%;13 cases underwent of ventricle drainage,accounting for 56.52%;7 cases were with intracerebral hemorrhage breaking into the ventricle,accounting for 30.43%;5 cases were with cerebrospinal fluid leakage,accounting for 21.73%.The drainage pollution occurred in 3 cases,accounting for 13.04%.8 cases were over 65 years old,accounting for 34.78%.9 cases were with diabetes,accounting for 39.13%.Not strict aseptic manipulation occurred in 8 cases,accounting for 34.78%;A long time catheter insertion took place in 5 cases,accounting for 21.73%.Conclusion Intracranial infections are easy to happen after minimally invasive surgery for hypertensive intracerebral hemorrhage,especially ventricle puncture and drainage or breaking into the ventricle of brain hemorrhage.So the sterile concept should be strengthened and more attentions should be paid to the aseptic technique to reduce or prevent the intracranial infection.Choose antibiotics of easily through the blood-brain barrier combined with intrathecal injection,which has a clear effect and can effectively improve the cure rate and reduce mortality.