神經外科術后顱內感染的預防和治療

[摘要] 目的 探討有效預防和治療神經外科術后顱內感染的措施，提高患者術后恢復率。方法 回顧方便選取的2015年1月—2016年1月期間于該院神經外科進行開顱手術的82例病例，隨機分為兩組，每組41例。預防組患者給予全面預防措施，對照組患者僅監測術后體征，及時治療出現顱內感染的患者。觀察兩組患者術后顱內感染的情況。 結果 比較兩組術后顱內感染的發病率，預防組感染5例，發病率12.20%，對照組感染14例，發病率34.15%，兩組患者術后顱內感染發病率比較差異有統計學意義（P<0.01）；分析發現，術后顱內感染的患者采用CSF培養及藥敏試驗特異性應用抗生素的方法治療后有顯著療效，預防組患者治療有效率100%，對照組患者治療有效率92.86%，兩組有效率比較差異無統計學意義（P>0.05）。結論 術前預防性應用抗生素、縮短手術時間，術后加強護理、注意飲食等可降低術后感染風險，根據CSF培養及藥敏試驗特異性應用抗生素可提高術后顱內感染的療效。

[關鍵詞] 神經外科；顱內感染；預防；治療

[中圖分類號] R651 [文獻標識碼] A [文章編號] 1674-0742（2016）10（b）-0014-03

[Abstract] Objective Discussion on effective measures to prevent and treat neurosurgical intracranial infections， improve postoperative recovery rate.Methods Convenient selection review between January 2015 to January 2016 in our hospital neurosurgery craniotomy surgery during 82 cases were randomly divided into prevention group and the control group， each group of 41 cases.Prevention group patients give comprehensive prevention measures of intracranial infection， the control group only keep monitoring postoperative patients with signs，timely treatment of intracranial infection patients.Compare two groups of patients of postoperative intracranial infection.Results Comparison of the two groups of patients the incidence of intracranial infection， infection prevention group 5 cases， the incidence of12.20%， 14 cases of infection in the control group， the incidence of 34.15%，the postoperative intracranial infection incidence difference was statistically significant （P <0.01）；the analysis found that patients with intracranial infection in cerebrospinal fluid culture and sensitivity test using specific antibiotic treatment methods have a significant effect， prevention group efficiency 100% ，control group efficiency 92.86%， the two groups there was no significant difference in efficiency （P> 0.05） treatment.Conclusion Preoperative prophylactic antibiotics， shorten the operation time and postoperative intensive care， attention to diet can reduce the risk of postoperative infection， cerebrospinal fluid culture and sensitivity test in accordance with specific antibiotics can increase intracranial infection treatment.

[Key words] Neurosurgery； Intracranial infection； Prevent； Treatment

顱內感染是神經外科術后最常見的并發癥，嚴重者可損傷中樞神經系統，治療不當或延誤易致殘甚至致死。國外某報道稱，術后顱內感染的發病率為1%～10%[1]。顱內感染治療較復雜，且預后極差[2]。目前治療以鞘內注射經藥敏試驗所得的敏感抗生素應用較為顯著。隨著細菌耐藥性的增強，抗生素的劑量和種類也在不斷調整。應用抗生素是顱內感染最常用的治療方法，但由于血腦屏障的存在，抗生素常規劑量難以在腦脊液中達到有效抑菌濃度，故明確術后顱內感染的原因并對因治療是治療的基本原則[3]。……