腰大池持续引流联合利奈唑胺静脉注射治疗高血压脑出血术后颅内感染的效果
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摘要
目的 分析腰大池持续引流联合利奈唑胺静脉注射治疗神经外科高血压脑出血术后颅内感染的效果。方法 选择2014年5月-2017年5月于医院治疗的颅内感染患者78例为研究对象,将采用利奈唑胺静脉注射等常规治疗方案的38例患者设为对照组,在此基础上联合腰大池持续引流治疗的40例患者设为研究组,比较两组患者治疗前后脑脊液常规检查结果、T淋巴细胞亚群及营养状况,并评价综合临床疗效。结果 78例患者共培养分离病原菌96株,其中革兰阴性菌34株占35.42%,革兰阳性菌62株占64.58%,以铜绿假单胞菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌和表皮葡萄球菌为主;研究组检出病原菌40株,对照组检出56株,两组患者检出病原菌种类差异无统计学意义(P=0.137);两组患者治疗后脑脊液蛋白、白细胞水平均降低,葡萄糖水平升高,且治疗后研究组以上指标分别为(0.43±0.08)mg/L、(0.65±0.09)×10~9/L、(4.34±0.21)mmol/L均优于对照组(P<0.001);研究组治疗后总蛋白(TP)、血红蛋白(Hb)、免疫球蛋白G(IgG)分别为(69.65±4.56)、(139.75±23.56)、(12.32±1.23)g/L高于对照组(P<0.001);治疗后研究组CD_3~+、CD_4~+、CD_4~+/CD_8~+分别为(34.23±4.34)%、(36.43±4.34)%、(1.43±0.25)高于对照组,CD_8~+为(22.23±2.45)%低于对照组,差异具有统计学意义(P<0.001);研究组疗效优于对照组(P=0.042)。结论 腰大池持续引流联合利奈唑胺治疗高血压脑出血术后颅内感染能提升临床疗效,改善患者免疫功能与营养状态。
OBJECTIVE To analyze the effect of lumbar cistern continuous drainage combined with linezolid intravenous injection in the treatment of intracranial infection after hypertensive cerebral hemorrhage. METHODS Seventy-eight patients with intracranial infection treated in the hospital from May 2014 to May 2017 were selected as the study subjects. 38 patients treated with linezolid intravenous injection and other routine treatment were set as the control group, and 40 patients treated with lumbar cistern continuous drainage in addition to routine treatment were included as the observation group. The results of routine cerebrospinal fluid, T-lymphocyte subsets and nutritional status before and after treatment were compared between the two groups. The comprehensive clinical efficacy was evaluated. RESULTS A total of 96 strains of pathogenic bacteria were isolated from the 78 patients, of which 34 strains were gram-negative bacteria(35.42%) and 62 strains were gram-positive bacteria(64.58%). 40 strains of pathogenic bacteria were detected in the study group and 56 strains in the control group. There was no significant difference in the types of pathogenic bacteria detected between the two groups(P=0.137). Pseudomonas aeruginosa, coagulase-negative Staphylococcus, Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens. After treatment, the levels of cerebrospinal fluid protein and leucocyte decreased and the level of glucose increased in both groups. After treatment, the above indexes in the study group were(0.43±0.08) mg/L,(0.65±0.09) ×10~9/L and(4.34±0.21) mmol/L, significantly better than those in the control group(P<0.001), and the total protein(TP), hemoglobin(Hb) and immunoglobulin G(IgG) in the study group were(69.65±4.56),(139.75±23.56) and(12.32±1.23) g/L, respectively, significantly higher than those in the control group(P<0.001). After treatment, CD_3~+, CD_4~+, CD_4~+/CD_8~+ in the study group were(34.23±4.34)%,(36.43±4.34)% and(1.43±0.25), higher than those in the control group, and CD_8~+ in the study group was(22.23±2.45)%, significantly lower than that in the control group, with significant differences(P<0.001). The curative effect of the study group was significantly better than that of the control group(P=0.042). CONCLUSION Lumbar cistern continuous drainage combined with linezolid intravenous injection can increase the clinical effect, and improve the immune function and nutritional status after hypertensive cerebral hemorrhage.
OBJECTIVE To analyze the effect of lumbar cistern continuous drainage combined with linezolid intravenous injection in the treatment of intracranial infection after hypertensive cerebral hemorrhage. METHODS Seventy-eight patients with intracranial infection treated in the hospital from May 2014 to May 2017 were selected as the study subjects. 38 patients treated with linezolid intravenous injection and other routine treatment were set as the control group, and 40 patients treated with lumbar cistern continuous drainage in addition to routine treatment were included as the observation group. The results of routine cerebrospinal fluid, T-lymphocyte subsets and nutritional status before and after treatment were compared between the two groups. The comprehensive clinical efficacy was evaluated. RESULTS A total of 96 strains of pathogenic bacteria were isolated from the 78 patients, of which 34 strains were gram-negative bacteria(35.42%) and 62 strains were gram-positive bacteria(64.58%). 40 strains of pathogenic bacteria were detected in the study group and 56 strains in the control group. There was no significant difference in the types of pathogenic bacteria detected between the two groups(P=0.137). Pseudomonas aeruginosa, coagulase-negative Staphylococcus, Staphylococcus aureus and Staphylococcus epidermidis were the main pathogens. After treatment, the levels of cerebrospinal fluid protein and leucocyte decreased and the level of glucose increased in both groups. After treatment, the above indexes in the study group were(0.43±0.08) mg/L,(0.65±0.09) ×10~9/L and(4.34±0.21) mmol/L, significantly better than those in the control group(P<0.001), and the total protein(TP), hemoglobin(Hb) and immunoglobulin G(IgG) in the study group were(69.65±4.56),(139.75±23.56) and(12.32±1.23) g/L, respectively, significantly higher than those in the control group(P<0.001). After treatment, CD_3~+, CD_4~+, CD_4~+/CD_8~+ in the study group were(34.23±4.34)%,(36.43±4.34)% and(1.43±0.25), higher than those in the control group, and CD_8~+ in the study group was(22.23±2.45)%, significantly lower than that in the control group, with significant differences(P<0.001). The curative effect of the study group was significantly better than that of the control group(P=0.042). CONCLUSION Lumbar cistern continuous drainage combined with linezolid intravenous injection can increase the clinical effect, and improve the immune function and nutritional status after hypertensive cerebral hemorrhage.
引文
[1] Gupta D.Subarachnoid space needle's eyelet in dural-arachnoid side-wall of lumbar cistern:Whitacre vs.Quincke[J].J Anaesthesiol Clin Pharmacol,2017,33(4):563-564.
[2] Tangen K,Narasimhan NS,Sierzega K,et al.Clearance of subarachnoid hemorrhage from the cerebrospinal fluid in computational and in vitro models[J].Ann Biomed Eng,2016,44(12):1-17.
[3] Ruan L,Wu D,Li X,et al.Analysis of microbial community composition and diversity in postoperative intracranial infection using high-throughput sequencing[J].Mol Med Rep,2017,16(4):3938-3946.
[4] Mo S,Wei L,Chen H,et al.A Chinese case of Prevotella intermedia and Streptococcus constellatus intracranial mixed infection[J].Metab Brain Dis,2018,33(1):161-166.
[5] Toescu SM,Lacey S,Low HL.First report of postoperative intracranial Weeksella virosa infection[J].Acta Neurochir (Wien),2017,159(11):2235-2238.
[6] 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):1985-1988.
[7] 中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[8] 史中华,徐明,陈光强,等.神经外科开颅术后颅内感染患者的脑脊液特点:附310例患者分析[J].中国中西医结合急救杂志,2018,25(1):24-27.
[9] 崔昱.病原生物学检验[M].北京:人民卫生出版社,2013:44-68.
[10] 杨生军,张春满,郝文炯.美罗培南联合万古霉素双途径给药治疗开颅术后颅内感染应用效果[J].临床军医杂志,2017,45(8):820-823.
[11] Mo S,Wei L,Chen H,et al.A Chinese case of Prevotella intermedia and Streptococcus constellatus intracranial mixed infection[J].Metab Brain Dis,2017,33(1):1-6.
[12] Offiah CE,Naseer A.Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era[J].Clin Radiol,2016,71(1):9-17.
[13] Dhawan SR,Gupta A,Gupta V,et al.Multiple Intracranial aneurysms in HIV infection[J].Indian J Pediatr,2016,83(8):1-3.
[14] Zuurbier SM,Coutinho JM,Stam J,et al.Clinical outcome of anticoagulant treatment in head or neck infection-associated cerebral venous thrombosis.[J].Stroke,2016,47(5):1271-1277.
[15] 卢立山.临床药师参与1例颅脑术后颅内感染药物治疗体会[J].中国药师,2016,19(9):1699-1701.
[16] 甘晓,张东波,刘向业,等.神经内镜联合不同抗菌药物治疗脑室-腹腔分流术后颅内感染的疗效分析[J].中华医院感染学杂志,2016,26(22):5156-5158.
[17] Jian G,Spivak ES,Wilkerson C,et al.Subdural empyema in the setting of multimodal intracranial monitoring[J].World Neurosurg,2017,97:749.e1-749.e6.
[18] 邱政,郑绍俭,张晓东,等.开颅手术患者术后颅内感染病原学特点及危险因素分析[J].中华医院感染学杂志,2017,27(20):4693-4696.
[19] Schaeffer E,Libert N,Lahutte M,et al.Cerebral venous sinus thrombosis and intracranial hemorrhage:a rare but classic complication of otorhinolaryngology infections[J].Intensive Care Med,2016,42(11):1811-1812.
[20] Iencean SM,Iencean AS.Vascular etiology of intracranial hypertension.[J].Kaohsiung J Med Sci,2016,32(7):389-390.
[21] Esenkaya A,Duzgun F,Cinar C,et al.Endovascular treatment of intracranial infectious aneurysms[J].Neuroradiology,2016,58(3):277-284.
[2] Tangen K,Narasimhan NS,Sierzega K,et al.Clearance of subarachnoid hemorrhage from the cerebrospinal fluid in computational and in vitro models[J].Ann Biomed Eng,2016,44(12):1-17.
[3] Ruan L,Wu D,Li X,et al.Analysis of microbial community composition and diversity in postoperative intracranial infection using high-throughput sequencing[J].Mol Med Rep,2017,16(4):3938-3946.
[4] Mo S,Wei L,Chen H,et al.A Chinese case of Prevotella intermedia and Streptococcus constellatus intracranial mixed infection[J].Metab Brain Dis,2018,33(1):161-166.
[5] Toescu SM,Lacey S,Low HL.First report of postoperative intracranial Weeksella virosa infection[J].Acta Neurochir (Wien),2017,159(11):2235-2238.
[6] 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):1985-1988.
[7] 中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[8] 史中华,徐明,陈光强,等.神经外科开颅术后颅内感染患者的脑脊液特点:附310例患者分析[J].中国中西医结合急救杂志,2018,25(1):24-27.
[9] 崔昱.病原生物学检验[M].北京:人民卫生出版社,2013:44-68.
[10] 杨生军,张春满,郝文炯.美罗培南联合万古霉素双途径给药治疗开颅术后颅内感染应用效果[J].临床军医杂志,2017,45(8):820-823.
[11] Mo S,Wei L,Chen H,et al.A Chinese case of Prevotella intermedia and Streptococcus constellatus intracranial mixed infection[J].Metab Brain Dis,2017,33(1):1-6.
[12] Offiah CE,Naseer A.Spectrum of imaging appearances of intracranial cryptococcal infection in HIV/AIDS patients in the anti-retroviral therapy era[J].Clin Radiol,2016,71(1):9-17.
[13] Dhawan SR,Gupta A,Gupta V,et al.Multiple Intracranial aneurysms in HIV infection[J].Indian J Pediatr,2016,83(8):1-3.
[14] Zuurbier SM,Coutinho JM,Stam J,et al.Clinical outcome of anticoagulant treatment in head or neck infection-associated cerebral venous thrombosis.[J].Stroke,2016,47(5):1271-1277.
[15] 卢立山.临床药师参与1例颅脑术后颅内感染药物治疗体会[J].中国药师,2016,19(9):1699-1701.
[16] 甘晓,张东波,刘向业,等.神经内镜联合不同抗菌药物治疗脑室-腹腔分流术后颅内感染的疗效分析[J].中华医院感染学杂志,2016,26(22):5156-5158.
[17] Jian G,Spivak ES,Wilkerson C,et al.Subdural empyema in the setting of multimodal intracranial monitoring[J].World Neurosurg,2017,97:749.e1-749.e6.
[18] 邱政,郑绍俭,张晓东,等.开颅手术患者术后颅内感染病原学特点及危险因素分析[J].中华医院感染学杂志,2017,27(20):4693-4696.
[19] Schaeffer E,Libert N,Lahutte M,et al.Cerebral venous sinus thrombosis and intracranial hemorrhage:a rare but classic complication of otorhinolaryngology infections[J].Intensive Care Med,2016,42(11):1811-1812.
[20] Iencean SM,Iencean AS.Vascular etiology of intracranial hypertension.[J].Kaohsiung J Med Sci,2016,32(7):389-390.
[21] Esenkaya A,Duzgun F,Cinar C,et al.Endovascular treatment of intracranial infectious aneurysms[J].Neuroradiology,2016,58(3):277-284.