腰大池置管持续引流联合鞘注敏感抗生素治疗脊柱术后椎管内感染的临床疗效分析
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摘要
目的:探讨腰大池置管持续引流联合鞘内注射敏感抗生素治疗脊柱开放性手术术后椎管内感染的临床效果。方法:2013年9月至2018年5月我院收治的脊柱因不同疾病行开放性手术治疗后椎管内感染患者9例,男4例,女5例,年龄35～67岁,平均52.83岁。所有患者均采用腰大池置管持续外引流联合鞘内注射敏感抗生素治疗,观察其临床疗效。结果:所有患者腰大池置管引流及鞘内注射敏感抗生素时间为7～21 d,平均11.4 d,临床治愈8例,1例因脑脊液3次培养为白假丝酵母菌感染而转入专科医院治疗,最终治愈出院,随访所有患者均未出现并发症。结论:开放性脊柱手术患者术后出现椎管内感染是罕见的严重并发症,发生原因与硬脊膜损伤脑脊液漏、手术创伤大、椎管开放时间长、糖尿病、长期服用糖皮质激素、低蛋白、低血色素等相关。在全身应用抗生素的前提下可采用腰大池置管持续外引流结合鞘内注射敏感抗生素治疗,该方法操作简便、创伤小、不良反应及并发症少、临床疗效确切。
Objective: To investigate the clinical effect of continuous lumbar cistern drainage combined with intrathecal injection of effective antibiotics on the treatment of intraspinal infection after open spinal surgery. Methods: A total of 9 patients who were admitted to our hospital from September 2013 to May 2018 and experienced intraspinal infection after open spinal surgery due to different diseases were enrolled. There were 4 male and 5 female patients, with a mean age of 52.83 years(35 ～ 67 years). All patients were treated with continuous lumbar cistern external drainage combined with intrathecal injection of effective antibiotics, and their clinical outcomes were observed.Results: The duration of lumbar cistern drainage and intrathecal injection of effective antibiotics ranged from 7 to21 days, with a mean duration of 11.4 days. Of all 9 patients, 8 achieved clinical cure, and 1 was transferred to a specialized hospital due to Candida albicans infection from three times of cerebrospinal fluid culture and was finally cured and discharged. No complications were observed during follow-up. Conclusion: Intraspinal infection is a rare and serious complication after open spinal surgery and is associated with various factors, including cerebrospinal fluid leakage due to dural injury, severe surgical trauma, a long opening time of the spinal canal, diabetes, long-term administration of glucocorticoids, low protein, and low hemoglobin. Under the premise of systemic application of antibiotics, continuous lumbar cistern external drainage combined with intrathecal injection of effective antibiotics can be used for treatment. This method is simple and convenient and has a marked clinical effect, with little trauma and fewer adverse effects and complications.
Objective: To investigate the clinical effect of continuous lumbar cistern drainage combined with intrathecal injection of effective antibiotics on the treatment of intraspinal infection after open spinal surgery. Methods: A total of 9 patients who were admitted to our hospital from September 2013 to May 2018 and experienced intraspinal infection after open spinal surgery due to different diseases were enrolled. There were 4 male and 5 female patients, with a mean age of 52.83 years(35 ～ 67 years). All patients were treated with continuous lumbar cistern external drainage combined with intrathecal injection of effective antibiotics, and their clinical outcomes were observed.Results: The duration of lumbar cistern drainage and intrathecal injection of effective antibiotics ranged from 7 to21 days, with a mean duration of 11.4 days. Of all 9 patients, 8 achieved clinical cure, and 1 was transferred to a specialized hospital due to Candida albicans infection from three times of cerebrospinal fluid culture and was finally cured and discharged. No complications were observed during follow-up. Conclusion: Intraspinal infection is a rare and serious complication after open spinal surgery and is associated with various factors, including cerebrospinal fluid leakage due to dural injury, severe surgical trauma, a long opening time of the spinal canal, diabetes, long-term administration of glucocorticoids, low protein, and low hemoglobin. Under the premise of systemic application of antibiotics, continuous lumbar cistern external drainage combined with intrathecal injection of effective antibiotics can be used for treatment. This method is simple and convenient and has a marked clinical effect, with little trauma and fewer adverse effects and complications.
引文
1.邓若毅,余利民,邵明,等.腰大池置管间断引流鞘内注射抗生素治疗胸腰椎术后脑脊液漏伴颅内感染[J].中国脊柱脊髓杂志,2015,25(3):287-288.
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4.van de Beek D,de Gans J,Spanjaard L,et al.Clinical features and prognostic factors in adults with bacterial meningitis[J].N Engl J Med,2004,351(18):1 849-1 859.
5.Durand ML,Calderwood SB,Weber DJ,et al.Acute bacterial meningitis in adults.A review of 493 episodes[J].N Engl J Med,1993,328(1):21-28.
6.谭博,刘绍明.神经外科术后颅内感染危险因素分析研究[J].中华神经外科疾病研究杂志,2015,14(3):283-285.
7.LEE K,RHO M,YU M,et al.A case of recurrent meningitis caused by R hodococcus species successfully treated with antibiotic treatment and intrathecal injection of vancomycin through an ommaya reservoir[J].Infect Chemother,2015,47(3):183-189.
8.Mombelli G,Klastersky J,Coppens L,et al.Gramnegative bacillary meningitis in neurosurgical patients[J].JNeurosurg,1983,59(4):634-641.
9.Twyman RS,Robertson P,Thomas MG.Meningitis complicating spinal surgery[J].Spine(Phila Pa 1976)1996,21(6):763-765.
10.曲志峰,曲艳春,陈文理,等.脑脊液置换联合万古霉素与地塞米松鞘内注射对术后颅内感染的临床研究[J].中国生化药物杂志,2014,34(2):84-85.
11.王森岗,赵建奇,敬谢攀,等.万古霉素鞘内注射与腰大池引流对高血压脑出血患者术后颅内感染治疗分析[J].中华医院感染学杂志,2015,(9):1 999-2 001
12.Tseng YY,Kao YC,Liao JY,et al.Biodegradable drugeluting polylactic-co-glycol acid nanofibers for the sustainable delivery of vancomycin to brain tissue:in vitro and in vivo studies[J].ACA Chem Neurosci,2013,4(9):1314-1 321.
13.郑一,王楠.美罗培南联合万古霉素鞘内注射治疗开颅术后颅内感染的临床观察[J].中国药房,2017,28(14):1 985-1 987.
14.崔大勇,鲁质成,綦斌,等.持续腰大池引流结合美罗培南鞘内注射治疗高血压脑出血术后颅内感染的疗效[J].中国老年病学杂志,2013,33(4):930-931.
15.阿扎提,郑鹏,刘德全,等.腰大池置管引流加鞘内注射治疗颅内感染的体会[J].中国社区医师,2014,30(27):14-16.
16.李扬,马晓东,任贺成,等.腰大池引流治疗术后颅内感染及脑脊液漏[J].中国临床神经外科杂志,2008,135:283-284
17.章国军,何民,杜杭根,等.腰穿与腰大池引流结合鞘内注射治疗开颅术后颅内感染的临床效果比较[J].中华医院感染学杂志,2014,24(2):444-446.
18.Coplin WM,Avellino AM,Kim DK,et al.Bacterial meningitis associated with lumbar drains:a retrospective cohort study[J].J Neurol Neurosurg Psychiatry,1999,67(4):468-473.
19.陈晓刚.鞘内注射头孢他啶与头孢曲松治疗脑室外引流术后颅内感染的疗效比较[J].临床合理用药杂志,2016,9(8A):9-10.
20.姚一,吴家阳,江建东,等.庆大霉素脊髓鞘内注射致下肢功能障碍1例[J].第三军医大学学报,2004,26(1):77.
21.TungYiLin,WenJerChen,MingKaiHsieh,et al.Postoperative meningitis after spinal surgery:a review of 21 cases from20,178patients[J].BMCInfectiousDiseases,2014,14:220.
2.deFreitas DJ,Mc Cabe JP.Acinetobacter baumanii meningitis:a rare complication of incidental durotomy[J].J Spinal Disord Tech 2004,17(2):115-116.
3.任晓辉,张扬,高之宪,等.神经外科术后颅内感染的影响因素及风险预测分析[J].中华神经外科杂志,2015,31(10):992-996.
4.van de Beek D,de Gans J,Spanjaard L,et al.Clinical features and prognostic factors in adults with bacterial meningitis[J].N Engl J Med,2004,351(18):1 849-1 859.
5.Durand ML,Calderwood SB,Weber DJ,et al.Acute bacterial meningitis in adults.A review of 493 episodes[J].N Engl J Med,1993,328(1):21-28.
6.谭博,刘绍明.神经外科术后颅内感染危险因素分析研究[J].中华神经外科疾病研究杂志,2015,14(3):283-285.
7.LEE K,RHO M,YU M,et al.A case of recurrent meningitis caused by R hodococcus species successfully treated with antibiotic treatment and intrathecal injection of vancomycin through an ommaya reservoir[J].Infect Chemother,2015,47(3):183-189.
8.Mombelli G,Klastersky J,Coppens L,et al.Gramnegative bacillary meningitis in neurosurgical patients[J].JNeurosurg,1983,59(4):634-641.
9.Twyman RS,Robertson P,Thomas MG.Meningitis complicating spinal surgery[J].Spine(Phila Pa 1976)1996,21(6):763-765.
10.曲志峰,曲艳春,陈文理,等.脑脊液置换联合万古霉素与地塞米松鞘内注射对术后颅内感染的临床研究[J].中国生化药物杂志,2014,34(2):84-85.
11.王森岗,赵建奇,敬谢攀,等.万古霉素鞘内注射与腰大池引流对高血压脑出血患者术后颅内感染治疗分析[J].中华医院感染学杂志,2015,(9):1 999-2 001
12.Tseng YY,Kao YC,Liao JY,et al.Biodegradable drugeluting polylactic-co-glycol acid nanofibers for the sustainable delivery of vancomycin to brain tissue:in vitro and in vivo studies[J].ACA Chem Neurosci,2013,4(9):1314-1 321.
13.郑一,王楠.美罗培南联合万古霉素鞘内注射治疗开颅术后颅内感染的临床观察[J].中国药房,2017,28(14):1 985-1 987.
14.崔大勇,鲁质成,綦斌,等.持续腰大池引流结合美罗培南鞘内注射治疗高血压脑出血术后颅内感染的疗效[J].中国老年病学杂志,2013,33(4):930-931.
15.阿扎提,郑鹏,刘德全,等.腰大池置管引流加鞘内注射治疗颅内感染的体会[J].中国社区医师,2014,30(27):14-16.
16.李扬,马晓东,任贺成,等.腰大池引流治疗术后颅内感染及脑脊液漏[J].中国临床神经外科杂志,2008,135:283-284
17.章国军,何民,杜杭根,等.腰穿与腰大池引流结合鞘内注射治疗开颅术后颅内感染的临床效果比较[J].中华医院感染学杂志,2014,24(2):444-446.
18.Coplin WM,Avellino AM,Kim DK,et al.Bacterial meningitis associated with lumbar drains:a retrospective cohort study[J].J Neurol Neurosurg Psychiatry,1999,67(4):468-473.
19.陈晓刚.鞘内注射头孢他啶与头孢曲松治疗脑室外引流术后颅内感染的疗效比较[J].临床合理用药杂志,2016,9(8A):9-10.
20.姚一,吴家阳,江建东,等.庆大霉素脊髓鞘内注射致下肢功能障碍1例[J].第三军医大学学报,2004,26(1):77.
21.TungYiLin,WenJerChen,MingKaiHsieh,et al.Postoperative meningitis after spinal surgery:a review of 21 cases from20,178patients[J].BMCInfectiousDiseases,2014,14:220.