脑室出血多次外引流术致颅内感染并发脑积水的5例分析

Intracranial infection and hydrocephalus after repeated external ventricular hemorrhage drainage: Analysis of 5 cases

目的脑室出血外引流术后并发感染和脑积水,在治疗上较为棘手,且预后不良。文中分析脑室出血外引流术后感染的原因和治疗方法。方法回顾分析5例脑室出血铸型患者的诊治过程。结果 5例患者均有2次以上手术史,1例为1次开颅术和1次脑室外引流术,另4例均有3次脑室外引流手术史,手术均在全身麻醉下进行。4例患者经脑室和腰大池引流、抗炎支持等治疗后感染控制,出现脑积水后行脑室腹腔分流,意识状态及神经功能均有好转,另1例感染未能控制死亡。结论反复多次脑室外引流是感染的原因之一,正确使用抗生素、充分的外引流和营养支持是十分关键的治疗方法。

Objective Intracranial infection after external ventricular hemorrhage drainage is difficult to be managed and has a poor prognosis. This study was to discuss the causes of intracranial infection after external ventricular hemorrhage drainage and the methods for its treatment. Methods We retrospectively analyzed the treatment procedures of 5 cases of ventricular hemorrhage. Results Four of the patients thrice underwent external vcntricular drainage, and the other 1 received craniotomy and external ventricular drainage, all under general anesthesia. The conscious status and nervous function were improved in 4 cases after ventricular and lumber cisterna drainage, infusion of antibiotics into the cisterna, and ventricle-peritoneal shunt against hydrocephalus, but 1 died of critical infection. Conclusion Repeated external ventricular drainage is one of the main causes of intracranial infection. External drainage, correct antibiotics, and nutritional support are important methods to control intracranial infection.