神经重症病人颅内感染的诊治进展

Progress in diagnosis and treatment of intracranial infection in patients of neurosurgery intensive care unit

神经重症病人因原发疾病和(或)并发症等因素易发生或合并颅内感染,颅内感染明显增加神经危重症病人的致残率和死亡率。神经重症病人颅内感染发生风险较普通病人高。颅内感染常见高危因素包括:高龄、手术时间长、多次手术、脑脊液漏、开放性伤口等。颅内感染诊断标准包括病原学诊断标准和临床诊断标准,脑脊液病原学及相关生物标志物的检测对于确诊细菌性颅内感染亦具有重要意义。颅内感染治疗有其特殊性和治疗特点,包括及早开始经验性抗菌药物治疗、据药敏结果及时调整、选择易透过血脑屏障的抗菌药物、推荐静脉给药、长疗程治疗、鞘内给药等,外科治疗和对症支持治疗亦相当重要。临床诊疗中从各细节入手积极防范颅内感染的发生。

Patients with critical neurological diseases are prone to or complicated with intracranial infection due to primary diseases and/or complications.Intracranial infection significantly increases the morbidity and mortality of patients with critical neurological diseases.The risk of intracranial infection is higher in critical neurological patients than those in general ward.The common risk factors for intracranial infection includes advanced age,long operation time,multiple operations,cerebrospinal fluid leakage,open wounds,etc.The diagnostic criteria of intracranial infection include etiological diagnostic criteria and clinical diagnostic criteria,and the detection of cerebrospinal fluid etiology and related biomarkers is also of great significance for the diagnosis of bacterial intracranial infection.The treatment of intracranial infection has its particularity and therapeutic characteristics,including early initiation of empirical antimicrobial therapy,timely adjustment according to drug sensitivity results,selection of antimicrobial agents that are easy to cross the blood-brain barrier,recommendation of intravenous administration,long-term treatment,intrathecal drug delivery,etc.Surgical treatment and symptomatic support treatment are also very important.It’s important to prevent the occurrence of intracranial infection from every clinical details.