腰大池持续引流联合万古霉素鞘内注射治疗颅脑术后颅内感染的临床观察

Clinical efficacy of continuous lumbar cisterna drainage combined with intrathecal injection of vancomycin in treatment of intracranial infections after craniocerebral operation

目的探讨腰大池持续引流联合万古霉素鞘内注射治疗颅脑术后颅内感染的临床疗效,为临床诊治提供参考。方法将62例颅脑术后感染患者随机分为治疗组与对照组,每组各31例;两组患者均采用万古霉素静脉和鞘内注射,治疗组在此基础上采用腰大池持续引流,引流时间1～2周,比较两组患者的临床疗效、颅内压变化及感染控制情况。结果治疗组临床治疗总有效率为93.5%,对照组总有效率为77.4%,两组差异有统计学意义(P<0.05);治疗后治疗组颅内压为(120.7±19.3)mm Hg、对照组(175.3±24.8)mm Hg,差异有统计学意义(P<0.05);治疗后两组脑脊液中白细胞、蛋白质含量均显著降低,而葡萄糖含量显著升高,治疗后治疗组白细胞、蛋白质及葡萄糖含量与对照组比较,差异均有统计学意义(P<0.05)。结论腰大池持续引流联合万古霉素鞘内注射治疗颅脑术后颅内感染安全有效,可明显改善感染症状,调节颅内压。

OBJECTIVE To explore the effect of continuous lumbar cisterna drainage combined with intrathecal injection of vancomyein on the treatment of intracranial infections after craniocerebral operation so as to provide basis for the clinical diagnosis and treatment. METHODS A total of 128 patients with intracranial infections, who underwent the craniocerebral operation, were randomly divided into the treatment group and the control group, all the cases were given the intravenous and intracranial infection of vancomycin, and the treatment group was treated with continuous lumbar cisterna drainage combined additionally. The clinical effect, change of intracranial pressure and infection control were compared and analyzed between two groups. RESULTS The total effective rate in the treatment group （93.5%） was significantly better than that in the control group （77. 4%） the difference was staticany significant （P〈0.05）. After the treatment, the intracranial pressure in the treatment group（120.7 ± 19.3 ） mmHg was significantly lower than that in the control group （175.3±24.8） mmHg, the difference was statistically significant （P〈0.05）. After the treatment, the contents of the leukocyte and protein were significantly reduced, but the content of glucose was remarkably increased （P〈0.05）. There were significant difference in the contents of the leukocyte, protein or glucose after the treatment between the observation group and the control group was statistically significant （P〈0.05）. CONCLUSION The continuous lumbar cisterna drainage combined with intrathecal injection of vancomycin is safe and effective in treatment of the intraeranial infections after craniocerebral operation and can significantly improve the symptoms of infections and regulate the intracranial pressure.