早期行腰池引流结合抗生素治疗脑室-腹腔分流术后感染的疗效分析

Clinical analysis of early lumbar drainage combined with antibiotic therapy in ventricular peritoneal shunt infection

目的探讨脑室．腹腔分流术（VPS）后感染早期应用腰池引流结合抗生素治疗的有效性及治疗中需注意的问题。方法选取自2008年1月至2015年6月河南省人民医院神经外科收治的应用腰池引流结合抗生素治疗VPS后感染患者22例，其中感染后3～7d内给予治疗16例（早期治疗组），8～10d内给予治疗6例（晚期治疗组），回顾性分析2组患者的临床资料和疗效。结果22例患者中脑脊液细菌培养阴性5例，凝固酶阴性葡萄球菌阳性10例，金黄色葡萄球菌2例、肠球菌2例，克雷白杆菌3例，其中金黄色葡萄球菌感染患者治愈率最低（0％），行腰池引流结合抗生素治疗后16例患者的感染治愈（72．7％），6例患者的感染未控制（27．3％），拔除脑室-腹腔分流管。早期治疗组患者的治愈率高于晚期治疗组（88％vs33％）。结论早期行腰池引流结合抗生素治疗可有效控制VPS后感染，避免了二次手术的风险和经济负担。

Objective To explore the effectiveness of early lumbar pool drainage combined with antibiotics treatment in remedying ventricle peritoneal shunt infection and the problems needed to be paid attention during the process of treatment. Methods Twenty-two patients with infection after ventricle peritoneal shunt, admitted to our hospital from January 2008 to June 2015, were given lumbar pool drainage combined with antibiotics treatment, including 16 with early lumbar pool drainage combined with antibiotics treatment （3-7 d of infection） and 6 with late lumbar pool drainage combined with antibiotics treatment （8-10 d of infection）. The clinical data and treatment efficacy were retrospectively analyzed. Results Bacterial culture of cerebrospinal fluid in the 22 patients indicated negative results in 5, coagulase negative staphylococcus in 10, staphylococcus aureus in two, enterococcus in two and klebsiella bacillus in three; the cure rate of patients with staphylococcus aureus was the lowest （0%）; after lumbar pool drainage combined with antibiotics treatment, the cure rate of these patients reached to 72.7% （16/22）; the infection of the left 6 patients could not be controlled, and therefore ventriculoperitoneal shunt was removed. The cure rate in patients with early treatment was better than that in patients with late treatment （88% vs. 33%）. Conclusion Early lumbar drainage combined with antibiotics can effectively control the ventricle peritoneal shunt infection, avoid risk of second operation and save economic burden.