目的 总结近十年来颅脑手术后颅内感染的发病率、病死率及病原菌谱，为制订预防颅内感染措施提供依据。 方法 检索中国学术期刊网全文数据库（CNKI）、万方数据库、重庆维普中文科技期刊全文数据库，并辅以文献追溯、手工检索等方法收集2001年－2012年国内正式刊物上公开发表的有关颅脑手术后颅内感染的中文文献。并对颅脑手术后颅内感染的流行病学调查资料进行Meta分析。 结果 共有27篇论文进入Meta分析，其中，25篇论文用于颅脑手术后颅内感染发病率的统计。共调查40 343例，发生颅内感染1 712例，感染率为4.24%。6篇论文提供了开颅术后颅内感染死亡的数据，在268例颅内感染患者中死亡39例，病死率为14.55%。15篇论文统计显示，颅内感染细菌培养阳性率为54.48%；15篇论文给出细菌培养结果，其中金黄色葡萄球菌占23.16%，表皮葡萄球菌占17.85%，铜绿假单胞菌占8.85%，大肠埃希菌占8.70%。 结论 国内颅脑手术后颅内感染以G+球菌为主，病原菌分布相对集中，临床上应予以重视。
方法 2008年9月-2009年11月，将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例，外引流组进行持续腰池置管脑脊液外引流，定期取引流脑脊液进行常规和生化检查；抗生素组采用静脉抗生素治疗。对两组颅内感染情况进行对比分析。 结果 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.
目的:观察颅内感染急性期血清钠氯浓度的改变及其临床意义。方法:对160例颅内感染血清钾钠氯浓度进行动态监测。结果:颅内感染组低钠低氯发生率显著高于对照组(P＜0.05),结脑患者最高、化脑次之、病脑患者最低,但均高于对照组。各组间血清钾钠氯水平差异无统计学意义(P＜0.05),但与对照组比较有显著性意义差异(P＜0.05)。结论:成人颅内感染急性期大部分存在明显的低钠低氯血症,且不同病原感染所致低钠低氯的水平不相同,颅内感染低钠低氯与患者病情轻重成正相关。故动态监测血清钾钠氯有助于颅内感染的诊断和鉴别诊断以及病情轻重和预后估计。
ObjectiveTo analyze the clinical characteristics of acquired immune deficiency syndrome (AIDS) complicated with intracranial infection and to explore the nursing countermeasures. MethodsWe retrospectively analyzed the clinical features, laboratory examination indexes, and nursing methods of 12 AIDS patients complicated with intracranial infection between January and December 2010. ResultsIn the 12 patients, 8 were male, 4 were female; 11 were married and 1 was unmarried. The first symptom of headache occurred in 8 patients, and feverin 4 patients. Detection of HIV-1P24 antigen in all the 12 patients with HIV was positive for nucleic acid analysis. After treatment and symptomatic care, 3 cases were cured, 3 quit the treatment voluntarily, 2 improved patients were transferred to a higher-level hospital, 3 patients were readmitted to our hospital after improvement of the situation, and 1 patient died. ConclusionThe most common symptom of AIDS was neural disease. The diagnosis should be based on clinical manifestations, and the epidemiological data should be used as reference. At the same time, attention should be paid to the admission assessment and good occupation protection, health education promotion, improvement of patients' quality of life, and reduction of the incidence of complications and mortality rate.
ObjectiveTo summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection. MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment. ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure. ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
Objective This study aimed to provide data about the clinical features of first seizure in the Ganzi Tibetan Autonomous Prefecture to improve the strategies for epilepsy prevention and control in this region. Methods We reviewed the clinical record of patients with first seizure in Neurology Department, Ganzi Tibetan Autonomous Prefecture People’s Hospital between January 2015 and October 2017 and summarised their clinical features. Results One hundred and one patients were included in this study with the average age of (43.0±18.4) years. Twenty-nine cases were diagnosed as statusepilepticus, 5 (17.2%) of whom died in 30 days. Among the 45 patients diagnosed with acute symptomatic seizure, 22 cases (48.9%) were caused by cerebral infection, including neurocysticercosis (n=4, 8.9%), tuberculous infection (n=8, 17.7%) and viral infection (n=7, 15.6%). Other causes of acute symptomatic seizure included cerebrovascular diseases (n=13, 28.8%), high altitude (n=3, 6.7%) and alcohol related or alcohol withdrawl (n=3, 6.7%). Conclutions These data suggest that the control of cerebral infections is essential for the prevention and treatment of seizures in the Ganzi Tibetan Autonomous Prefecture. Education of local primary doctors about status epilepticus will enable better management of seizures in this population.