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目的探讨后颅窝肿瘤术后仅合并颅内感染的早期临床特点及抗菌药物治疗效果。方法回顾性分析重庆医科大学附属第一医院神经外科2014年3月至2016年3月显微神经外科手术治疗的后颅窝肿瘤患者195例,依据术后仅合并颅内感染的纳入排除标准,分析早期颅内感染的临床特点、脑脊液(cerebrospinal fluid,CSF)检查结果。依据不同时期经验性抗感染治疗药物分成碳青霉烯类组和联合用药组(碳青霉烯类+万古霉素),比较两组治疗效果。结果共计纳入26例,术后发热时间为(6.2±3.7)d,经验性抗感染治疗时间为(7.1±3.4)d,首次腰椎穿刺时间为(7.9±3.5)d,脑脊液有核细胞数高峰期为(10.2±3.3)d,首次和高峰期有核细胞数分别为(665.4±324.6)×106/L、(1 935.1±1 437.3)×106/L,后者较首次明显升高(P<0.05)。CSF培养阳性5例,以G-菌为主,单用碳青霉烯类组治疗时间(16.6±7.7)d,联合用药组治疗时间(15.5±4.8)d,两组差异无统计学意义(P>0.05)。结论后颅窝肿瘤术后颅内感染早期临床特点无特异性,且CSF培养阳性率低,术后疑似颅内感染需多次CSF检查,尽早经验性使用抗G-菌药物。
Objective To investigate the early clinical features of posterior fossa tumor combined with intracranial infection and the effect of antibacterial therapy. Methods A retrospective analysis of 195 patients with posterior fossa tumors treated by neurosurgery in Department of Neurosurgery, First Affiliated Hospital of Chongqing Medical University from March 2014 to March 2016 was based on inclusion exclusion criteria for postoperative combined intracranial infection only, Analysis of the clinical features of early intracranial infection, cerebrospinal fluid (CSF) test results. According to different periods of empirical anti-infectives, the drugs were divided into carbapenem group and combination group (carbapenems + vancomycin). The therapeutic effect was compared between the two groups. Results A total of 26 patients were included in this study. The duration of postoperative fever was (6.2 ± 3.7) days, the duration of empirical anti-infective therapy was (7.1 ± 3.4) days, the first time of lumbar puncture was (7.9 ± 3.5) days, and the number of cerebrospinal fluid nucleated cells The number of nucleated cells at the first and peak was (665.4 ± 324.6) × 106 / L and (1935.1 ± 1 437.3) × 106 / L, respectively, the latter was significantly higher than the first <0.05). CSF culture positive in 5 cases, mainly G-bacteria, carbapenem alone group treatment time (16.6 ± 7.7) d, combination therapy group treatment time (15.5 ± 4.8) d, there was no significant difference between the two groups ( P> 0.05). Conclusions The posterior cranial fossa tumor posterior intracranial infection early clinical features of nonspecific, and CSF culture positive rate is low, postoperative suspected intracranial infection need multiple CSF examination, as early as possible empirical use of anti-G-bacteria drugs.