脓肿腔局部用药对脑脓肿患者全身抗生素疗程的影响

The effect of stereotactic intracavity injection of antibiotics on systemic antibiotics therapy in patients with brain abscess

目的探讨通过脓肿腔内应用抗生素缩短细菌性脑脓肿患者全身抗生素应用疗程的可行性。方法收集2005年1月至2018年6月解放军总医院第六医学中心神经外科收治的107例细菌性脑脓肿患者(共155个脓肿),均采用立体定向脓肿抽吸,并于脓肿腔内应用高浓度抗生素、结合全身抗生素疗法治疗,设为腔内治疗组。同时将1995年1月至2004年12月采用常规立体定向手术并结合全身抗生素治疗的51例细菌性脑脓肿患者设为常规治疗组。比较两组的临床特征、治疗方法以及临床预后。结果腔内治疗组的随访时间为6~72个月,平均(26.2±12.5)个月。所有脓肿均获治愈,影像学检查未见脓肿复发。未发现与局部抗生素应用相关的并发症。腔内治疗组患者中,78例恢复良好,21例有轻度神经功能缺损症状,3例有中度神经功能缺损症状,1例仍处于植物生存状态,4例死于其他疾病或意外。腔内治疗组的全身抗生素应用疗程短于常规治疗组[分别为(21.5±2.3)d、(36.3±5.2)d,t=25.765,P<0.001];且脓肿复发率更低(分别为0%、5.9%,χ^2=6.057,P=0.014)。两组患者术后神经功能状态的差异无统计学意义(P>0.05)。结论对于脑脓肿患者,脓肿腔内局部应用抗生素可缩短全身抗生素治疗的疗程。相对于常规治疗而言,这种治疗方式亦降低了脓肿复发率。

Objective To investigate the feasibility of intracavity administration of high-dose antibiotics to shorten the course of systemic antibiotic therapy. Methods A total of 107 patients with bacterial brain abscesses (155 abscesses) who were treated with stereotactic aspiration and intracavity injection of high-dose antibiotic combined with systemic antibiotic therapy(intracavitary treatment group) at Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center from January 2005 to June 2018 were enrolled in this study. From January 1995 to December 2004, 51 patients with bacterial brain abscesses who were admitted to Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center were treated with traditional stereotactic surgery (traditional treatment group). Clinical characteristics, treatment and prognosis in the 2 groups were compared. Results During the follow-up period (mean: 26.2±12.5 months, range: 6-72 months), all the abscesses of the intracavitary treatment group subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 78 patients had good outcomes, 21 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 4 died of accidents not related to brain abscesses. The course of systemic antibiotic application in the intracavitary treatment group was shorter than that in the traditional treatment group (21.5±2.3 d vs. 36.3±5.2 d, t=25.765, P<0.001). The recurrence rate of abscess was lower (0% vs. 5.9%,χ^2=6.057, P=0.014). There was no significant difference in postoperative neurological status between the 2 groups (P>0.05).Conclusions Our preliminary results indicated that the local application of antibiotics in brain abscess cavity could reduce the length of time of systemic antibiotic therapy. This treatment could reduce the abscess recurrence rate compared to traditional treatment.