亚低温配合人工脑脊液置换治疗颅内感染
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摘要
背景:
颅内感染是神经外科的常见并发症,而且致残率和死亡率都很高。
由于血脑屏障的存在,常规静脉给药对某些中枢神经系统疾病难以达到良好的疗效。而脑脊液与脑组织之间仅有室管膜或软膜阻隔,物质交换更容易,易取得更好的疗效。
目前,我国临床医生行脑脊液置换术、鞘内药物注射时,仍用生理盐水,从理论上讲,用生理盐水取代脑脊液对已有损伤的脑组织将造成新的损伤。因此,应用类似于脑脊液的人工脑脊液取代生理盐水,能在最大程度上起到保护神经组织的作用。
亚低温治疗对脑组织的保护作用已得到许多临床和实验证实,配合治疗颅内感染效果良好。
目的:
寻求颅内感染的最佳治疗方案。
方法:
选择符合一定条件的患者共31名,随机分为处理组1(亚低温配合脑室内人工脑脊液置换治疗)、处理组2(运用脑室内人工脑脊液置换治疗,不配合亚低温治疗)、处理组3(单纯亚低温治疗)和处理组4(脑室内生理盐水置换治疗)。间断监测颅内压并辅以亚低温治疗,监测指标:体温、血常规、脑脊液压力、生化及常规。观察项目为:感染控制时间、临床症状改善时间、平均住院日,并对患者进行预后评级和安全性评价。比较以上观察项目在各组之间的差别。
结果:
我们发现(1)亚低温配合脑室内人工脑脊液置换治疗对重症颅内感染其预后明显优于单纯予脑室内人工脑脊液置换治疗;(2)脑室内人工脑脊液置换治疗重症颅内感染其预后明显优于常规治疗手段;(3)人工脑脊液置换治疗重症颅内感染其预后优于生理盐水脑脊液置换治疗。
结论:亚低温配合脑室内人工脑脊液置换治疗重症颅内感染优于以往常规治疗手段,人工脑脊液的使用可明显降低生理盐水置换所带来的对脑组织的再损伤,改善临床预后。
Background:Intracranial infection is a common complication of neurosurgery, it has high mutilation rates and mortality rates.Due to blood brain barriers, routine vein administration could hardly gain satisfactory therapeutic effects in some CNS diseases. There is only ependyma or piamater between the cerebralspinal fluid and brain tissue, so it is easier for matter exchange and therapeutic effects would be more optimal.At present, clinical doctors still use normal sodium in cerebrospinal fluid replacement and intraspinal injection of medication, but this will induce secondary damages to the injured brain tissue. Because of this, using artificial cerebrospinal fluid replacing normal sodium mayhave better protective effects on central nervous system (CNS).Although studies have approved the protective effects of moderate hypothermia treatment on the brain tissue, cerebrospinal fluid replacement combined with the moderate hypothermia treatment will gain more better effects on intracranial infection diseases. Objective :To explore the best treatment for intracranial infection. Methods:Patients were randomly divided into 4 groups, the experimental group l(artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment), the experimental group 2 (only artificial cerebrospinal fluid replacement) , experimental group 3(only the moderate hypothermia treatment) and experimental group 4 (only normal sodium replacement). Monitoring indexes as follows: body temperature (BT), routine blood test, the pressure of cerebralspinal fluid, the routine tests and biochemistry tests of cerebralspinal fluid. Observing items: the time of infection control, the time of clinical symptom improvement and the mean hospitalization time. At last,evaluating prognosis and safety, Comparing the differences in the 4 experimental groups. Results:(1) Artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment is significantly better than artificial cerebrospinal fluid replacement alone;(2) Artificial cerebrospinal fluid replacement is significantly superior to the conventional therapy;
(3) Artificial cerebrospinal fluid replacement is significantly superior to normal sodiumreplacement.Conclusion:Artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment has more advantages over conventional therapy, replacement normal sodium with artificial cerebrospinal fluid can provide maximum extent protections for CNS and better clinical prognosis.
颅内感染是神经外科的常见并发症,而且致残率和死亡率都很高。
由于血脑屏障的存在,常规静脉给药对某些中枢神经系统疾病难以达到良好的疗效。而脑脊液与脑组织之间仅有室管膜或软膜阻隔,物质交换更容易,易取得更好的疗效。
目前,我国临床医生行脑脊液置换术、鞘内药物注射时,仍用生理盐水,从理论上讲,用生理盐水取代脑脊液对已有损伤的脑组织将造成新的损伤。因此,应用类似于脑脊液的人工脑脊液取代生理盐水,能在最大程度上起到保护神经组织的作用。
亚低温治疗对脑组织的保护作用已得到许多临床和实验证实,配合治疗颅内感染效果良好。
目的:
寻求颅内感染的最佳治疗方案。
方法:
选择符合一定条件的患者共31名,随机分为处理组1(亚低温配合脑室内人工脑脊液置换治疗)、处理组2(运用脑室内人工脑脊液置换治疗,不配合亚低温治疗)、处理组3(单纯亚低温治疗)和处理组4(脑室内生理盐水置换治疗)。间断监测颅内压并辅以亚低温治疗,监测指标:体温、血常规、脑脊液压力、生化及常规。观察项目为:感染控制时间、临床症状改善时间、平均住院日,并对患者进行预后评级和安全性评价。比较以上观察项目在各组之间的差别。
结果:
我们发现(1)亚低温配合脑室内人工脑脊液置换治疗对重症颅内感染其预后明显优于单纯予脑室内人工脑脊液置换治疗;(2)脑室内人工脑脊液置换治疗重症颅内感染其预后明显优于常规治疗手段;(3)人工脑脊液置换治疗重症颅内感染其预后优于生理盐水脑脊液置换治疗。
结论:亚低温配合脑室内人工脑脊液置换治疗重症颅内感染优于以往常规治疗手段,人工脑脊液的使用可明显降低生理盐水置换所带来的对脑组织的再损伤,改善临床预后。
Background:Intracranial infection is a common complication of neurosurgery, it has high mutilation rates and mortality rates.Due to blood brain barriers, routine vein administration could hardly gain satisfactory therapeutic effects in some CNS diseases. There is only ependyma or piamater between the cerebralspinal fluid and brain tissue, so it is easier for matter exchange and therapeutic effects would be more optimal.At present, clinical doctors still use normal sodium in cerebrospinal fluid replacement and intraspinal injection of medication, but this will induce secondary damages to the injured brain tissue. Because of this, using artificial cerebrospinal fluid replacing normal sodium mayhave better protective effects on central nervous system (CNS).Although studies have approved the protective effects of moderate hypothermia treatment on the brain tissue, cerebrospinal fluid replacement combined with the moderate hypothermia treatment will gain more better effects on intracranial infection diseases. Objective :To explore the best treatment for intracranial infection. Methods:Patients were randomly divided into 4 groups, the experimental group l(artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment), the experimental group 2 (only artificial cerebrospinal fluid replacement) , experimental group 3(only the moderate hypothermia treatment) and experimental group 4 (only normal sodium replacement). Monitoring indexes as follows: body temperature (BT), routine blood test, the pressure of cerebralspinal fluid, the routine tests and biochemistry tests of cerebralspinal fluid. Observing items: the time of infection control, the time of clinical symptom improvement and the mean hospitalization time. At last,evaluating prognosis and safety, Comparing the differences in the 4 experimental groups. Results:(1) Artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment is significantly better than artificial cerebrospinal fluid replacement alone;(2) Artificial cerebrospinal fluid replacement is significantly superior to the conventional therapy;
(3) Artificial cerebrospinal fluid replacement is significantly superior to normal sodiumreplacement.Conclusion:Artificial cerebrospinal fluid replacement combined with the moderate hypothermia treatment has more advantages over conventional therapy, replacement normal sodium with artificial cerebrospinal fluid can provide maximum extent protections for CNS and better clinical prognosis.
引文
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2.赵志刚,陈旭,彭名炜.对300例神经外科患者抗生素应用调查分析.中华医院感染学杂志,1997,7(4):243.
3. Clmenza JW, Kaltman SI,Diamond DL. Craniofasial trauma and cerebrospinal fluid leakage: aretrospective clinical studay. [J] Oral Maxillofac Surg,1995,53:1004.
4. Korinek AM. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients[J]. Neurosurgery, 1997, 41 (5): 1079-1081.
5. Infections in neurosurgery working party of the British society for antimicrobial chemotherapy. Antimicrobial prophylaxis in neurosurgery and after head injury [J]. L ancet, 1994, 349 (9065): 1574-1581
6. Morrow BA, Starcevic VP, Keil LC and Seve Am WB. Intracranial hypertension after cerebroventdcular infusions in conscious rats [J] Physiol Regulatory Integrative Comp Physiol, May 1990;258: 1170.
7. Morrow BA, Starcevic VP, Keil LC and Severs WB. Dexamethasone and ergonovine effects on cerebrospinal fluid pressure in conscious rats [J].Pharmacology, Sep 1994;49(3): 199-204.
8. Grady PA and Blaumanis OR. Cerebral venous blood gas tensions in elevated intracranial pressure[J]. Stroke, Sep 1986;17: 946.
9. Lin Y, Tsuchihashi T, Matsumura K, Fukuhara M, Ohya Y, Fujii K, and Iida M. Central cardiovascular action of urotensin Ⅱ in spontaneously hypertensive rats.Hypertens Res, Oct 2003;26(10): 839-45.
10. Kaiser AB,M cGee ZA. Am inoglyco side therapy of gram-negative bacillary meningitis. N Engl J Med, 1975, 293 (24): 1215-1220.
11.尚爱加,程东源,周定标.清洁开颅手术后颅内感染的治疗[J].中华医院感染学杂志,2002;02:22-24。
12.乔丽琴;王志明;闫淑英.颅脑手术后颅内感染的成因及治疗[J].中国综合临床,2002;11:975-976.
13.吴锋.鞘内注射治疗颅内感染的临床进展[J]..中国综合临床,2002;12(18):1059-1060.
14.刘窗溪,万登济,李健龙,等.颅脑手术后颅内感染临床分析[J].中华医院感染学杂志,2000,10(1):426.
15.王秉玉,陈若平,侍行文,等.脑室外引流方法与感染[J].上海第二医科大学学报,2000,17(1):40-41.
16. Pons VG, Denlinger SL, Guglielmo BJ, et al. Ceftizoxime versus vancomycin and gentamicin in neurosurgical prophylaxis: Arandomized prospective blinded clinical study[J]. Neurosurgery, 1993,33: 416.
17.江基尧,朱诚.国外亚低温与脑损伤的研究进展.国外医学·神经病学神经外科学分册,1993,20:4.
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