脑积水脑室腹腔分流相关性脑室炎治疗方案的探讨

目的探讨脑积水脑室腹腔分流相关性脑室炎的治疗方法。方法对临床怀疑有脑脊液分流管性感染的患者,先拔除原分流管．同时行脑室外引流术．取脑室内脑脊液行细菌培养和抗生素敏感试验检查。术后,在获得细菌培养结果前．每日经脑室外引流管注入万古霉素25～50mg;在获得细菌培养结果后,确定或调整使用抗生素的种类。在脑室炎治愈后,根据需要最终对脑积水给予合理的治疗。结果11例患者中感染凝固酶阴性或表皮葡萄球菌及金黄色葡萄球菌者共9例,其中1例感染阴沟杆菌、克雷伯杆菌和产气肠杆菌;1例感染链球菌;1例感染牛粪杆菌。药敏试验表明：9例患者感染的球菌对万古霉素均敏感,但其中仅1例对庆大霉素敏感。1例感染链球菌和2例感染杆菌者,均有各自敏感的抗生素。在临床治疗中,万古霉素实际有效者8例;抗生素治疗疗程为16～36d。11例患者全部存活,其中9例神经功能明显改善。结论①脑室内注入抗生素是一种治疗脑室炎可靠而有效的方法。②万古霉素是治疗脑室炎的首选药物,少数患者需要加用或改用其他抗生素。③系统性抗生素治疗的作用尚不能肯定,可在感染表现期辅助使用。④脑室炎的诊断和治疗还涉及很多问题,有待广泛而深入的研究。

Study on treatment strategy for ventriculitis associated with ventriculoperitoneal shunt for hydrocephalus

OBJECTIVE: To study the treatment strategy for ventriculitis associated with ventriculo peritoneal shunt for hydrocephalus. METHODS: For all of the patients suspected to have cerebrospinal fluid (CSF) infections, the first step of treatment was removal of the "infected" shunts, then a ventricular drainage was placed in frontal horn of the ventricle, and at the same time CSF was obtained from the ventricle for bacterial culture and tests of bacterial sensitivities to antibiotics. After the shunt removal and before the result from bacterial cultures was obtained, 25-50 mg of vancomycin was administered intraventricularly daily. As soon as the result from bacterial cultures was obtained, antibiotics should be adjusted according to the sensitivity test result. By the time of the infections being controlled, appropriate treatments including reshunting would finally be given for hydrocephalus if necessary. RESULTS: Among 11 patients, 9 were infected with coagulase-negative Staphylococci or Staphylococcus epidermidis and Staphylococcus aureus, one of them with concomittent infection of aerobacter cloacae, Klebsiella pneumoniae and enterobacteriaceae aerogenesis, 1 patient with Streptococci, and another one with Mycobacterium stercoris bovis. The tests of drug sensitivity showed that cocci in infection of 9 patients were all sensitive to vancomycin, but only 1 of them sensitive to gentamycin. There were other sensitive antibiotics for streptococcus in 1 case and for bacillus in 2 patients. Practically vancomycin was effective for 8 of 11 patients, including one case of streptococcal infection. The duration for anti-infection treatment was in a range of 16-36 days. Finally, all of 11 patients survived from the shunt ventriculitis, and 9 of them had significant improvement in their neurological functions. CONCLUSION: (1)Intraventricular administration of proper antibiotics is a reliable and effective way to treat ventriculitis associated with ventriculoperitoneal shunts. (2)Vancomycin is the preferred antibiotic for ventriculitis, but other kind(s) of some antibiotics are necessary in a few patients in addition to or instead of vancomycin. (3)The effect of systemic use of antibiotics could not be defined in this series of patients, but this may be used as an adjunct in the practice. (4)There are many problems related to diagnosis and treatment of shunt ventriculitis that should be studied more extensively and deeply.