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目的:总结重型颅脑外伤术后颅内感染,气管切开合并肺部感染患者有效诊治方法。方法:对32例神经外科重型颅脑外伤术后颅内感染,气管切开合并肺部感染患者的临床资料进行回顾性分析。诊断颅内感染患者,先采用经验用药,如头孢曲松或加用万古霉素静脉滴注,并每天行1~2次腰穿;严重感染伴发热患者腰穿鞘内注入抗生素及腰大池持续引流;经过上述治疗措施一月无效后,停用所有抗生素,输注血浆等增加患者自身抵抗力。结果:32例患者均行脑脊液细菌培养,其中8例阳性且耐药,通过常规的一个月抗生素静滴,腰穿鞘内注入抗生素及腰大池持续引流,患者颅内感染未见明显好转,但之后停用所有抗生素,输注血浆等增加患者体内抵抗力,全部患者均获治愈。结论:颅内感染应做到早期诊断与治疗,选择敏感的抗生素及合理的给药途径是治疗颅内感染的关键措施,但细菌培养结果对所有的抗生素均耐药时,停用所有的抗生素,防止多重耐药菌感染,增强患者的自身免疫能力抵抗感染,能获得好的效果。
Objective: To summarize the effective diagnosis and treatment of intracranial infection after traumatic brain injury and tracheotomy with pulmonary infection. Methods: The clinical data of 32 patients with intracranial infection and tracheotomy with pulmonary infection after severe traumatic brain injury in neurosurgery were analyzed retrospectively. Diagnosis of intracranial infection patients, the first use of empirical medication, such as ceftriaxone or add vancomycin intravenous infusion, and 1 or 2 times a day lumbar perfusion; severe infection with fever in patients with lumbar puncture and intrathecal antibiotics and lumbar lasted for Drainage; after the above treatment measures in January invalid, disable all antibiotics, infusion of plasma and other patients to increase their own resistance. RESULTS: Thirty-two patients underwent bacterial culture of cerebrospinal fluid, of which 8 were positive and resistant. Continuous intravenous infusion of antibiotics and lumbar lumbar drainage through lumbar puncture and intubation continued without any significant improvement in intracranial infection After stopping all antibiotics, infusion of plasma and other patients to increase body resistance, all patients were cured. Conclusion: Intracranial infection should be diagnosed and treated early. The selection of sensitive antibiotics and reasonable route of administration are the key measures for the treatment of intracranial infection. However, all the antibiotics should be discontinued when the bacterial culture results are resistant to all the antibiotics , To prevent multiple drug-resistant bacterial infections, enhance the patient’s ability to resist the infection of the immune system, can get good results.