腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的疗效和安全性

The efficacy and safety of lumbar cistern drainage combined with intrathecal injection in treatment of pan-drug resistant Acinetobacter baumannii intracranial infection

目的研究腰大池引流加鞘内注射运用在地市级医院开颅术后泛耐药鲍曼不动杆菌颅内感染中的价值。方法对2018—2022年鄂州市中心医院60例开颅术后泛耐药鲍曼不动杆菌颅内感染患者治疗情况进行回顾性分析,根据治疗方法进行分组,研究组(n=30)和对照组(n=30)均于确诊感染后立即给予静脉抗生素治疗8周,研究组同时行腰大池引流加鞘内注射,对照组同时行腰穿鞘内注射,两组后一治疗疗程根据脑脊液复查情况确定。评价两组抗生素治疗8周后的总有效率,统计患者体温恢复时间、脑膜刺激征缓解时间、颅内压升高缓解时间及不良反应情况,对比治疗前后及两组间血液中C反应蛋白(CRP)、降钙素原(PCT)、神经元特异性烯醇化酶(NSE)及脑脊液中白细胞计数(WBC)、中性粒细胞百分比(NEUT)、蛋白质、葡萄糖水平。结果研究组总有效率为86.67%,高于对照组的63.33%(χ^(2)=4.365,P<0.05)。研究组体温恢复时间、脑膜刺激征缓解时间、颅内压升高缓解时间均短于对照组(P<0.01)。研究组抗生素治疗8周后血液中CRP、PCT、NSE水平均低于对照组(P<0.05),脑脊液中NEUT、蛋白质、WBC水平低于对照组,但葡萄糖水平高于对照组(P<0.05)。研究组不良反应低于对照组(10.00%vs 33.33%,P<0.05)。结论对开颅术后泛耐药鲍曼不动杆菌颅内感染患者,腰大池引流加鞘内注射的效果更为理想,可促进症状减轻,快速控制感染,改善脑脊液环境,不良反应少,安全性高,可在地市级医院推广使用。

Objective To study the value of lumbar cistern drainage combined with intrathecal injection in the treatment of pan-drug resistant Acinetobacter baumannii intracranial infection after craniotomy in prefecture level hospitals.Methods A retrospective study was conducted on the treatment of 60 patients with pan-drug resistant Acinetobacter baumannii intracranial infection after craniotomy at Ezhou Central Hospital from 2018 to 2022.Intravenous antibiotics were given for 8 weeks immediately after the infection was confirmed in study group(n=30)and control group(n=30),and the study group received lumbar cistern drainage plus intrathecal injection at the same time,while the control group underwent intrathecal injection at the same time,and the latter treatment courses of the two groups was determined according to the review of cerebrospinal fluid.The total effective rates in the two groups were evaluated after 8 weeks of antibiotic treatment,and the time of recovery of body temperature,remission of meningeal irritation,remission of elevated intracranial pressure and adverse reactions were counted.The blood levels of C-reactive protein(CRP),procalcitonin(PCT),neuron-specific enolase(NSE),while cerebrospinal fluid(CSF)levels of white blood cell count(WBC),neutrophil percentage(NEUT),protein and glucose were compared before and after treatment between two groups.Results The total effective rate of the study group was 86.67%,higher than 63.33%of the control group(χ^(2)=4.365,P<0.05).The time for temperature recovery,relief of meningeal irritation sign,and relief of intracranial pressure increase in the study group were all shorter than those in the control group(P<0.01).After 8 weeks of antibiotic treatment,the blood levels of CRP,PCT,and NSE of the study group were lower than those of the control group(P<0.05)and the CSF levels of NEUT,protein and WBC were lower than those of the control group,but glucose was higher than that of the control group(P<0.05).The adverse reaction in the study group were 10.00%,lower than that in the control group(33.33%,P<0.05).Conclusion For patients with intracranial infection caused by pan-drug resistant Acinetobacter baumannii after craniotomy,the effect of lumbar cistern drainage combined with intrathecal injection is more ideal,which can promote symptom relief,quickly control infection,improve CSF environment,reduce adverse reactions,and have high safety.It can be promoted and used in prefecture level hospitals.