腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的临床疗效分析

Clinical efficacy of lumbar cistern drainage combined with intrathecal injection in treating intracranial infection with Acinetobacter baumannii

摘要:

目的 探讨腰大池引流加鞘内注射治疗泛耐药鲍曼不动杆菌颅内感染的疗效和安全性。方法 回顾性分析2018年4月—2019年12月本院神经外科收治的26例泛耐药鲍曼不动杆菌颅内感染患者的临床资料，所有患者均接受腰大池引流及鞘内注射抗生素，观察并记录患者感染指标（体温、颈项强直征、血常规、脑脊液常规及生化、脑脊液细菌培养）变化情况，记录治疗方法并对治疗效果进行分析。结果 24例患者行单纯性腰大池引流，2例患者因腰大池引流管堵塞，重置腰大池引流管并联合侧脑室引流。23例患者在治疗10~34 d内治愈，治愈率为88.46%；3例患者死亡，死亡率11.54%，死亡时间分别为感染确认后第4天、第7天、第12天。结论 对泛耐药鲍曼不动杆菌颅内感染患者应用腰大池引流加鞘内注射治疗是安全有效的，值得临床推广。如发生因脑脊液蛋白含量高导致腰大池引流管堵塞，可联合侧脑室引流并行腰大池-侧脑室方向替加环素溶液持续冲洗。

Abstract:

Objective To investigate the efficacy and safety of lumbar cistern drainage combined with intrathecal injection in treating intracranial infection with Acinetobacter baumannii. Methods A retrospective analysis was performed on the clinical data of 26 patients with intracranial infection with extensively drug-resistant A. baumannii who were admitted to the Neurosurgery Department of our hospital from April 2018 to December 2019. All patients were treated with lumbar cistern drainage combined with intrathecal injection of antibiotics. The changes in indicators of intracranial infection, including body temperature, neck stiffness, blood routine parameters, cerebrospinal fluid routine and biochemical parameters, and bacterial culture results of cerebrospinal fluid, were observed and recorded. The therapeutic methods were recorded, and the therapeutic efficacy was analyzed. Results Twenty-four patients were given lumbar cistern drainage alone, and the other two underwent a replacement of lumbar cistern drainage tube and were given lateral ventricular drainage additionally due to obstruction of the lumbar cistern drainage tube. Twenty-three patients were cured within 10-34 days of treatment (cure rate 88.46%), and the other three died (mortality rate 11.54%). The death time of the three patients was 4 days, 7 days and 12 days, respectively, after the confirmation of intracranial infection. Conclusions Lumbar cistern drainage combined with intrathecal injection is safe and effective in treating patients with intracranial infection with extensively drug-resistant A. baumannii, which holds promise for clinical application. If the high protein concentration in the cerebrospinal fluid causes obstruction of the lumbar cistern drainage tube, lateral ventricular drainage can be given additionally, and the tigecycline solution can be continuously irrigated from the lumbar cistern drainage tube to the lateral ventricular drainage tube.