CAJ | 학술논문

背景：创伤性或医源性的硬脊膜缺损可引发持续性脑脊液漏，甚至进展为危及生命的化脓性脑膜炎。当脑脊液漏合并脑膜炎时，由于脑脊液为细菌良好的培养基，同时因血脑屏障的存在，大多数抗生素不易到达脑脊液内，所以脑膜炎一旦发生表现为发病急、进展快、感染不易控制。目的：评价生物材料修补破损硬脊膜后，腰大池置管引流加鞘内给药治疗脊柱术后脑脊液漏合并脑膜炎的疗效。方法：新疆医科大学第六附属医院脊柱外科2008年6月至2013年6月共进行脊柱手术2266例，术后发生脑脊液漏126例，发生率为5.56%，其中合并脑膜炎者12例。患者术中发现硬脊膜破损者，直接缝合或取自体筋膜片修补。所有病例进行彻底的清创，静脉使用敏感抗生素，然后行腰大池置管持续引流，同时将敏感抗生素(一般用万古霉素)自腰大池引流管鞘内注入给药，一期关闭切口。回顾分析12例患者的病历资料及治疗结果。结果与结论：12例患者脑脊液漏出现时间为术后24-72 h，平均48 h；感染出现时间为术后8-12 d，平均9.5 d。鞘内注射万古霉素后第2天头痛、发热等症状明显缓解，腰大池置管引流7-14 d后颅内感染症状完全消失，脑脊液生化及常规检查连续3次均正常，普通细菌培养无菌生长，将腰大池引流管拔除。所有患者无因腰大池置管引流引起的椎管内感染、低颅压性头痛、脑疝等并发症。提示，自体筋膜修补硬脊膜联合腰大池置管引流加鞘内给药对脊柱术后脑脊液漏合并脑膜炎的治疗是有效的。
배경：창상성혹의원성적경척막결손가인발지속성뇌척액루，심지진전위위급생명적화농성뇌막염。당뇌척액루합병뇌막염시，유우뇌척액위세균량호적배양기，동시인혈뇌병장적존재，대다수항생소불역도체뇌척액내，소이뇌막염일단발생표현위발병급、진전쾌、감염불역공제。목적：평개생물재료수보파손경척막후，요대지치관인류가초내급약치료척주술후뇌척액루합병뇌막염적료효。방법：신강의과대학제륙부속의원척주외과2008년6월지2013년6월공진행척주수술2266례，술후발생뇌척액루126례，발생솔위5.56%，기중합병뇌막염자12례。환자술중발현경척막파손자，직접봉합혹취자체근막편수보。소유병례진행철저적청창，정맥사용민감항생소，연후행요대지치관지속인류，동시장민감항생소(일반용만고매소)자요대지인류관초내주입급약，일기관폐절구。회고분석12례환자적병력자료급치료결과。결과여결론：12례환자뇌척액루출현시간위술후24-72 h，평균48 h；감염출현시간위술후8-12 d，평균9.5 d。초내주사만고매소후제2천두통、발열등증상명현완해，요대지치관인류7-14 d후로내감염증상완전소실，뇌척액생화급상규검사련속3차균정상，보통세균배양무균생장，장요대지인류관발제。소유환자무인요대지치관인류인기적추관내감염、저로압성두통、뇌산등병발증。제시，자체근막수보경척막연합요대지치관인류가초내급약대척주술후뇌척액루합병뇌막염적치료시유효적。
BACKGROUND:Traumatic or iatrogenic dural defects can cause persistent cerebrospinal fluid leakage, even progressing to life-threatening purulent meningitis. In patients with meningitis combined with cerebrospinal fluid leakage, most antibiotics are unable to enter the cerebrospinal fluid, as the cerebrospinal fluid is a good medium for bacteria and there is the presence of blood-brain barrier. So meningitis presents with acute onset, rapid development and infection difficult to control. OBJECTIVE:To evaluate the outcome of continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics for postoperative cerebrospinal fluid leakage combined with meningitis after biomaterial repair of dural defects. METHODS: A retrospective study was carried out to review the 12 cases of cerebrospinal fluid leakage combined with meningitis among 126 of 2 266 cases who developed cerebrospinal fluid leakage (5.56%) undergoing spinal surgery from June 2008 to June 2013. During the operation, dural defects were directly sutured or repaired with autologous fascial sheet. Al cases underwent thorough debridement and intravenous injection of sensitive antibiotics folowed by continuous lumbar drainage and intrathecal administration of sensitive antibiotics (usualy vancomycin), and then the incision was closed at stage I. RESULTS AND CONCLUSION:The cerebrospinal fluid leakage was found in the 12 cases at 24-72 hours after surgery, averagely 48 hours; the infection was found at 812 days days after surgery, averagely 9.5 days. Headache and fever were significantly relieved at the 2nd day of intrathecal administration of antibiotics, and intracranial infection disappeared at 7-14 days after continuous lumbar drainage. Biochemical test of the cerebrospinal fluid and routine examination were done thrice, and the results were al normal. No bacterial growth was found in bacterial culture test, and the drainage tube was removed. There was no intraspinal infection, intracranial hypotension headache and hernia caused by the drainage tube. These findings indicate that autologous fascia repair combined with continuous lumbar subarachnoid drainage plus intrathecal administration of antibiotics is an effective method in the treatment of cerebrospinal fluid leakage with meningitis.