脑室-腹腔分流术后颅内感染的处理经验

目的总结脑室-腹腔分流术后颅内感染的临床特点和治疗效果。方法 2003年1月至2009年1月行脑室-腹腔分流术治疗脑积水患者254例,其中11例分流术后并发颅内感染。对颅内感染者在脑脊液细菌培养和药敏试验结果出来前,通过腰椎穿刺置管鞘内注射可在鞘内应用的广谱抗生素,并持续引流感染的脑脊液;细菌培养和药敏试验结果出来后,选用敏感抗生素鞘内注射;10例病情严重者拔除分流装置,行脑室外引流。结果 11例患者,1例经腰椎穿刺置管鞘内注射抗生素后治愈,10例不断调整引流装置同时脑室内注入抗生素后治愈。结论脑脊液脑室外引流、鞘内或脑室内注射抗生素,以及必要时拔除分流装置是治疗脑室-腹腔分流术后颅内感染的主要措施。

Experience in treating the intracranial infection after ventriculo-peritoneal shunt in the patients with hydrocephalus

Objective To explore the clinical character and treatment of intracranial infection after ventriculo-peritoneal shunt（VPS） in the patients with hydrocephalus.Methods Eleven of 254 patients with hydrocephalus undergoing VPS in our hospital from January,2003 to January,2009 suffered from intracranial infection after VPS.The clinical manifestation was analyzed,and the cerebrospinal fluid（CSF） was examined by lumbar puncture in 11 patients with intracranial infection.The intrathecal injection of the suitable broad-spetrum antibiotics was performed in all the patients with intracranial infection before the results of bacterial culture of CSF and drug sensitivity test.The sensitive antibiotics were intrathecally injected in the patients with intracranial infection after the results of bacterial culture of CSF and drug sensitivity test.The shunt devices were pulled out and the external ventricular drainage of CSF was performed in 10 patients with severe intracranial infection.Results Eleven patients with intracranial infection were cured.Conclusion The main measures to treat the intracranial infection after VPS include intrathecal or intraventricular injection of sensitive antibiotics,external ventricular drainage of CSF and removal of the shunt device if necessary in the patients with hydrocephalus.