脑室—腹腔分流术后感染26例诊治分析

目的探讨脑室—腹腔分流术后感染的早期诊断和治疗原则。方法回顾性分析26例脑室—腹腔分流术后感染病例的诊断和治疗办法,所有病例均进行血液和脑脊液的培养及影像学检查。结果 2例死于感染并发症,2例感染复发,21例患者重新安装分流装置,3例病情较轻的患者经分流泵及鞘内给药后痊愈。结论脑室—腹腔分流术后的早期诊断非常重要,一些非特异性的症状和体征需引起重视。对于感染的病例,及时移除分流装置,同时行脑室外引流冲洗和脑室内注药,当脑脊液达到无菌状态后重新植入分流装置是行之有效的办法。结果表明抗感染应首选万古霉素、第三代头孢菌素或改为美罗培南,待获得培养结果后根据药敏试验针对性用药。脑脊液培养以金黄色葡萄球菌和表皮葡萄球菌多见,经治疗再次培养结果均为阴性。

The diagnosis and treatment of 26 case with ventriculoperitoneal shunt infection

Objective To explore the early diagnosis and treatment principles of ventriculoperitoneal shunt infection.Method 26 cases with infections after ventriculoperitoneal shunt operation were analysised.All the cases were examined by the blood,cerebrospinal fluid(CSF) bacterial culture and imaging examination.Result 2 cases died from complications of shunt infections,2 cases had a recurrent shunt infection,the new shunts were re-implanted in 21 cases,3 cases without removing the shunt device were cured.Conclusion The early diagnosis of ventriculoperitoneal shunt infection is very important,some non-specific symptoms and signs shall be paid more attention.The cases with postoperative infection shall be taken positive measures,the management protocol consisting of the removal of the infected shunt,intraventricular antibiotic treatment and external drainage,and the placement of a new shunt at right time was a valid method.