脑脓肿的临床治疗与预后分析

Clinical treatment and prognosis of brain abscess

目的探讨脑脓肿的临床治疗与预后。方法回顾性分析中南大学湘雅医院神经外科2009年1月至2014年10月收治的脑脓肿患者94例,收集分析临床资料、手术方式、疗效与并发症。患者平均年龄39.2±13.2岁。仅用抗菌药物治疗12例,脓肿腔钻孔引流55例,开颅手术27例,抗菌药物平均使用29.9天。结果手术后死亡5例,术后随访死亡2例,死亡率7.4%。脓液常规培养中细菌培养阳性27例,阳性率为32.9%,其中以链球菌和葡萄球菌为主。术后随访患者格拉斯哥预后评分(GOS)5分69例,4分患者12例。单因素分析结果显示术前患者昏迷、多房多发脓肿是预后不良的影响因素(P<0.05)。结论脑脓肿早诊断早治疗对患者预后极为关键。脑脓肿的治疗方案需要根据个体情况采取个体化措施,脓肿腔穿刺效果良好,损伤小,适用于绝大多数患者。

Objective To investigate the clinical treatment and prognosis of brain abscess. Methods Ninety-four patients with brain abscess who were admitted to the Department of Neurosurgery in our hospital from January 2009 to October 2014 were retrospectively analyzed. The clinical data,surgical approach,treatment outcomes,and complications were collected and analyzed. The age of these patients averaged 39. 2 ± 13. 2 years. In these patients,12 received antibiotic therapy alone,55 received abscess aspiration and drainage,and 27 received craniotomy. The duration of antibiotic therapy averaged 29. 9 days. Results In the 94 patients,2 died after surgery and 2 died during the postoperative follow-up,yielding a mortality rate of 7. 4%. Bacteria,mainly streptococci and staphylococci,grew in conventional culture from pus of 27 patients,resulting in a positive rate of 32. 9%. The postoperative follow-up showed that 69 patients had a Glasgow Outcome Scale score of 5 and 12 patients had 4. The results of the univariate analysis showed that preoperative coma and multi-room or multiple abscesses were risk factors for poor prognosis（ P〈0. 05）. Conclusions Early diagnosis and treatment are quite important for the prognosis of brain abscess. The treatment regimen for brain abscess should be personalized. For most patients,abscess puncture achieves satisfactory outcomes with little damage.