摘要
目的总结神经外科术后多重耐药鲍曼不动杆菌脑室炎的诊疗经验。方法回顾我院神经外科监护室2009年9月至2013年5月收治的6例多重耐药鲍曼不动杆菌脑室炎病例。所有病例经脑室外引流,急性期行抗生素脑室内灌洗,联合静脉用药,对疗效进行分析,并随访1-3年。结果 5例治愈,脑脊液细菌培养转阴时间7-35 d,平均（15.8±2.7）d;1例重症动脉瘤性蛛网膜下腔出血患者因难治性颅高压导致脑疝,院内死亡。治愈患者均因脑积水2-6周行分流手术,无再次感染,其中4例预后较好,1例原发病为脑外伤后植物状态患者无改善。结论多重耐药鲍曼不动杆菌感染可导致急性化脓性脑室炎,必须尽早诊断,及时予以治疗,早期脑室灌洗、脑室引流联合静脉及脑室内抗生素治疗,效果较好,值得推广。
Objective To summarize the treatment of post-neurosurgical ventriculitis caused by multi-drug resistant acinetobacter baunannii. Methods Six cases were treated in our neurosurgical ICU from Sep 2009 to May 2013 and their data were retrospectively reviewed regarding extra-ventricular drainage（EVD）, antibiotics treatment and their effectiveness, clinical course and outcome. EVD was performed for all patients. Early clearance of ventricular empyema was performed in early stage by antibiotics fluid flushing, combined with intrathecal and systemic antibiotics treatment. Patients were followed up for 1 to 3 years. Results Five patients survived and four patients had good outcome after ventriculoperitoneal（VP） shunt. One vegetative patient stayed no improvement. Cerebrospinal fluid culture became negative in7-35 d, with the mean of（15.8 ± 2.7） days. Four patients underwent VP shunt in 2 to 6 weeks after the infection being cured. One severe aneurysmal subarachnoid hemorrhage patient died in hospital with refractory increased intracranial pressure and herniation. Conclusion Post-neurosurgical multi-drug resistant acinetobacter baunannii ventriculitis can go through empyema and lead to poor outcome. Once the diagnosis is confirmed, the treatment methods we provided should be tried for its good efficacy.
出处
《北京医学》
CAS
2015年第11期1075-1077,共3页
Beijing Medical Journal
基金
北京市医院管理局临床医学发展专项(ZY201309)
首都特色应用研究与成果推广(Z151100004015095)
