后颅窝肿瘤手术后颅内感染临床特征分析

Clinical Characteristics of Intracranial Infection after Posterior Fossa Surgery

【目的】探讨本院后颅窝肿瘤患者外科治疗后颅内感染临床特征。【方法】回顾性分析2008年1月至2018年1月本收治的191例后颅窝肿瘤患者的临床资料。对其术后并发颅内感染的25例(13.09%),对患者临床症状相关指标进行监测记录包括体温、C反应蛋白(CRP)、外周血白细胞数(WBC)、CSF检查结果、血清降钙素原(PCT)进行监测;对高峰期及首次CSF检查结果、生化指标、腰椎穿刺时间进行比较。【结果】颅内感染患者均有不同程度的发热症状,术后发热时间(6.21±3.72)d,WBC为(14.32±4.78)×10^9/L,体温(38.17±0.42)℃,CRP为(28.54±14.34)mg/L,PCT为(2.44±0.45)ng/mL;以上指标均显著升高[CRP≤10mg/L,WBC(4-10)×10^9/L,PCT<0.5ng/mL为正常水平]。患者感染控制时间为(15.58±4.89)d。患者高峰期CSF检查有核细胞数、蛋白含量显著高于首次,高峰期氣化物含量低于首次,差异具有统计学意义(P<0.05)。CSF培养结果显示共5例呈阳性(20.00%),其中革兰阴性菌4例,分别为缓症链球菌、溶血葡萄球菌、奥斯陆莫拉菌、鲍曼不动杆菌复合群、大肠埃希菌、施氏假单胞菌;CSF培养两种不同株细菌1例,分别为缓症链球菌(G^+)、大肠埃希菌(G^-)。【结论】后颅窝肿瘤患者外科治疗后颅内感染早期临床特点无特异性,患者CSF培參具有较低的阳性率,外科治疗后临床应对疑似颅内感染的患者多次进行CSF检查,抗革兰阴性菌药物应尽早经验性使用。

【Objective】To investigate th ors after surgical treatment.【Methods】The clinical data of 191 patients with poste-rior fossa tumors from January 2008 to January 2018 were retrospectively analyzed.25 patients(13.09%)with intracranial infection after operation,were monitored and recorded,including body temperature,C-reactive protein(CRP),peripheral blood leukocyte count(WBC),CSF examination results,serum procalcitonin(PCT),and the results of peak and first CSF examination,biochemical indicators,lumbar puncture time were compared January 2018 were selected.Postoperative intracranial infection in 25(13.09%)patients.The clinical symptoms and signs of patients with intracranial infection were monitored and recorded,including body temperature,C reactive protein,peripheral blood leukocyte count,CSF test results,serum procalcitonin monitoring.The peak time,the first CSF test results,biochemical indicators,lumbar puncture time were compared(continuous CSF examination of the highest number of nuclear cells in the time that is the peak number of CSF nucleated cells,if the first time the number of CSF patients with the highest nuclear cells,then according to the patient first time).The therapeutic effect and treatment time of the two groups were compared.The results of CSF culture were analyzed.[ResultsJAll the patients with intracranial infection had fever symptoms of varying degrees.The fever time after operation was(6.21±72)d,WBC was(14.32±4.78)×10^9/L,body temperature was(38.17±0.42)℃,CRP was(28.54±14.34)mg/L,PCT was(2.44±0.45)ng/mL.The above indexes were significantly increased[CRP<10 mg/L,WBC(4-10)×10^9/L,PCT<0.5 ng/mL was normal!.The infection control time was(15.58±4.89)days.The number of nucleated cells and protein content of CSF in peak period were significantly higher than those in the first time,and the chloride content in peak period was lower than that in the first time(P<0.05).CSF culture results showed that 5 cases were positive(20.00%).Four of them were gram-negative bacteria,including Streptococcus mitigatus,Staphylococcus hemolyticus,Moraxella Oslo,Acinetobacter baumannii complex,Escherichia coli and Pseudomonas sp.Two different strains of bacteria were cultured by CSF in one case,they were Streptococcus mitigatus(G^+)and Escherichia coli(G^-).【Conclusion】The early clinical characteristics of intracranial infection,in patients with posterior cranial fossa tumors after surgical treatment are not specific.The CSF culture of patients has a low positive rate.After surgical treatment,patients suspected of intracranial infection should be examined by CSF many times.Anti-gram-negaitive drugs should be used empirically as soon as possible.