后颅窝相关术后近期颅内感染的临床分析

目的探讨后颅窝相关手术后近期感染临床特征及治疗方法。方法回顾性分析2001年1月至2011年11月行后颅窝相关手术治疗的980例患者的临床资料,对术后1月内出现颅内感染患者临床特征进行分析。结果980例患者中,术后1月内发生颅内感染69例,发生率为7.04%。69例颅内感染中革兰氏阳性球菌10例、革兰氏阴性杆菌46例,13例脑脊液培养无细菌生长。给予鞘内注射敏感抗生素、全身静脉用药及脑脊液置换治疗,68例患者治愈;因颅内感染死亡3例,死亡率0.31%。鞘内注射后发生癫痫发作12例,单或双侧下肢麻木、无力23例,大小便失禁2例,分别给予保守治疗后症状缓解。结论后颅窝相关手术后颅内感染发生率高,发生颅内感染应尽快行脑脊液细菌培养＋药敏试验,积极给予敏感抗生素治疗。

Clinical analysis of intracranial infection after surgery involving posterior fossa

Objective To explore the causes and treatment of intracranial infection within one month after surgery involving posterior fossa. Method The clinical data of 980 patients who underwent surgery involving posterior fossa through posterior median approach were analyzed retrospectively. Results Of 980 patients, 69 had intracranial infections within one month after surgery. The overall rate of intracranial infection was 7.04%. According to the outcomes of cerebrospinal fluid culture, 10 patients were infected with Gram-positive bacteria, 46 with Gram-negative bacteria and 13 without detectable bacteria. Fifty-six patients with positive bacterial infections were treated with sensitive antibiotics by intravenous drips and intrathecal injection for 7-15 days. The other 13 patients with negative bacterial infections were treated with beta-lactam antibiotics by intrathecal injection combined with vancomyein or teicomycin by intravenous drips for 7-15 days. Sixty-six patients were cured and 3 died. The numbness and incomplete paralysis of lower limbs occurred in 23 patients and epilepsia occurred in 12 patients. Conclusions The surgery involving posterior fossa has a high rate of intraeranial infection within one month after operation, but the infection rate can be decreased by careful preoperative planning and skillful techniques. The treatment of sensitive antibiotics should be performed in patients with postoperative intracranial infection as early as definite diagnosis of intracranial infection being made.