颅脑手术后鲍曼不动杆菌颅内感染的临床分析

Clinical analysis of postoperative intracranial infection due to acinetobacter baumannii in neurosurgery

目的探讨颅脑手术后鲍曼不动杆菌颅内感染的临床特点和治疗方案。方法15例术后鲍曼不动杆菌颅内感染患者均通过临床表现及脑脊液培养确诊；结合药敏试验和患者病情，选择合理抗生素静脉注射；及时行腰大池引流术，选择敏感、安全的抗生素进行鞘内或脑室内注射；积极防治并发症，并加强营养支持治疗；动态监测脑脊液培养，根据药敏试验结果调整抗生素。结果所有患者均为术后鲍曼不动杆菌颅内感染，其中脑脊液切口漏8例，脑室外引流术4例，腰池引流术2例，脑脊液鼻漏1例；9例多重耐药，6例广泛耐药；总治愈率为66．7％，其中多重耐药治愈率为77．8％，广泛耐药治愈率为50．0％。结论术后脑脊液切口漏、脑室外引流是术后鲍曼不动杆菌颅内感染的主要原因，早期诊断，及时行腰大池持续引流炎性脑脊液，合理选择抗生素联合静脉、鞘内或脑室内注射用药，并积极防治全身并发症，加强营养支持治疗，可提高治愈率。

Objective To explore the clinical features and treatment of postoperative intraeranial infection due to acinetobacter baumannii in neurosurgery. Method A total of 15 cases of postoperative intracranial infection due to acinetobacter baumannii were diagnosed by clinical manifestations and cerebrospinal fluid（CSF） culture. All patient received intravenous antibiotics according to drug sensitive test and patient＇s condition while they were taken following measures： timely lumbar drainage, subarachnoid space or intraventricular antibiotic injection, positive prevention and treatment of complications, enhancing nutritional support, dynamic monitoring on CSF culture, and the adjustment of antibiotic according to drug sensitive test results. Results All patients, included 8 cases of CSF leakage of incision,4 external ventricular drainage ,2 lumbar cistem drainage and 1 CSF rhinorrhea were infected by acinetobacter baumannii after neurosurgerical operation. The total cure rate was 66.7%. There were 9 cases of muti-drug resistant acinetobacter baumannii（ curative rate 77.8% ）and 6 cases of extensive drug resistant acinetobacter banmannii（curative rate 50% ）. Conclusion CSF leakage of incision and external ventricular drainage was the main causes of intracranial infection due to acinetobacter baumannii. Early diagnosis, timely lumbar drainage and continuous drainage of inflammatory CSF, reasonable choice of antibiotics combined intravenous and subarachnoid space or intraventricular injection could improve the cure rate for this disease.