B超引导下经前囟侧脑室穿刺诊治婴幼儿脑室膜炎

Puncture of the Lateral Ventricle through the Anterior Fontanel Guided by Ultrasonography Dynamically for the Diagnosis and Treatment of Ventriculitis in Infant

目的 改善婴幼儿化脑合并脑室膜炎的诊断与治疗。方法 利用超声波实时引导下床边经前囟测脑室穿刺 ,分析脑室液变化 ,诊断并结合静脉用药 ,辅以脑室内给药治疗脑室膜炎。结果 2 1例化脑中检出脑室膜炎 12例 ;脑室膜炎组共穿刺 2 7(平均 2 .3± 1.5 )人次 ,一次成功率为 10 0 % ,其中 2例酚红试验提示CSF循环阻塞 ;12例脑室膜炎脑室内给药共 10 4(平均 8.6± 7.7)人次 ;单、双侧脑室固定持续引流分别为 10、2例 ,仅 1例在引流期间发生脑室出血 ,经调整引流针尖位置后出血停止 ;9例治愈或好转 ,3例死亡 ,死亡率 2 5 %。结论 实时超声引导下经前囟侧脑室穿刺能动态观测穿刺、脑室给药及引流过程 ,应用于诊治化脑合并脑室膜炎是安全、简便和有效的。

Objective To improve the diagnosis and treatment of the ventriculitis in purulent meningitis of infants. Methods Punctures of the lateral ventricles through anterior fontanel were performed bedsidely under the guidance of real time ultrasonography in twenty one cases of infantile purulent meningitis. Following the punctures, combined with iv infusion, ventricular injections of antibiotics once daily or every other day were carried out for curing of the ventriculitis according to the analyses of the venticular fluid. Results Twenty seven (mean 2.3±1.5) person times of punctures were performed, by which 12 cases of ventriculitis were diagnosed in the group of purulent meningitis, and obstruction of cerebrospinal fluid circulation was suggested in 2 cases with ventriculitis during phenol red tests. The first attempt successful rate was 100%. One hundred and four(mean 8.6±7.7)person times of ventricular injection were admitted in all the cases of ventriculitis. The persistent fixed drainage in these cases was also supervised by ultrasonography serially. Of the group,9 cases got improvement or cure ,3 cases died, the mortality was 25%. Conclusion With the characteristics of safety and forthright, the taps of lateral ventricle through the fontanel guided by ultrasound dynamically and promptly is useful for diagnosing and treating the ventriculitis. [