高场强MR引导下精准穿刺抽吸联合脓肿腔局部用药治疗脑脓肿的疗效及其对感染相关指标的影响

Effect of high field MR guided precise aspiration combined with local medication in abscess cavity in the treatment of brain abscess and its influence on infection related indicators

目的探究高场强MR引导下精准穿刺抽吸联合脓肿腔局部用药治疗脑脓肿的疗效及其对感染相关指标的影响。方法该研究采用前瞻性研究,以徐州地区多中心2019年6月至2020年6月诊断并治疗的脑脓肿患者100例作为研究对象,将患者随机分为观察组和对照组,每组50例,所有患者均采取抗菌药物治疗,对照组采取脓肿穿刺引流、穿刺抽脓或者手术切除术等手术方式,观察组患者手术方式采用高场强MR引导下精准穿刺抽吸联合脓肿腔局部用药治疗,比较两组患者的治疗效果、美国国立卫生研究院卒中量表(NIHSS)评分、运动功能、认知功能及感染相关指标之间的差异。结果观察组的脓肿清除率(98.00%)明显高于对照组(86.00%),差异有统计学意义(P<0.05);经过治疗后,两组患者术后3、5、7、10 d的NIHSS评分的组内差异、组间差异及总差异均有统计学意义(P<0.05);治疗后,两组患者的Fugl-Meyer评估量表(FMA)、日常生活能力(ADL)、简易智力状态检查(MMSE)、长谷川痴呆量表(HDS)评分均明显升高,且观察组的这几项评分均明显高于对照组,差异均有统计学意义(P<0.05);两组患者的C反应蛋白(CRP)、降钙素原(PCT)水平均明显下降,且观察组的CRP、PCT水平均明显低于对照组,差异有统计学意义(P<0.05)。结论经过高场强MR引导下精准穿刺抽吸联合脓肿腔局部用药治疗脑脓肿,患者的神经功能及运动功能明显改善,感染情况得到明显改善,治疗效果明显,建议临床推广。

Objective To study the effect of high field MR guided precise aspiration combined with local medication in abscess cavity in the treatment of brain abscess and its influence on infection related indicators.Methods This study was a prospective study.The patients with brain abscess diagnosed and treated in multicenters in Xuzhou area from June 2019 to June 2020 were selected as the research objects.The patients were randomly divided into observation group and control group,50 cases in each group.All patients were treated with antibiotics.The control group was treated with abscess puncture and drainage,puncture and pus extraction or surgical resection.Patients in the observation group were treated with high field MR guided precise puncture aspiration combined with local medication in abscess cavity.The differences of treatment effect,National Institute of Health Stroke Scale(NIHSS)score,motor function,cognitive function and infection related indicators were analyzed.Results The abscess clearance rate in the observation group(98.00%)was significantly higher than that in the control group(86.00%),and the difference was statistically significant(P<0.05).After treatment,there were significant differences in NIHSS scores between the two groups at 3,5,7 and 10 days after operation(P<0.05).The Fugl-Meyer evaluation method(FMA),activities of daily living(ADL),mini-mental state examination(MMSE),Hasegawa dementia scale(HDS)scores in the two groups were significantly increased,and these scores in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).The C-reactive protein(CRP)and procalcitonin(PCT)of the two groups decreased significantly,and the CRP and PCT in the observation group were significantly lower than those in the control group,the difference was statistically significant.Conclusion In the treatment of brain abscess,precise puncture and aspiration guided by high field MR combined with local medication in abscess cavity can significantly improve the neurological function and motor function of patients,significantly ameliorate the infection situation,and the treatment effect is significant.It is suggested that it could be promoted in clinical practice.