70例腦膿腫臨床分析
發(fā)布時(shí)間：2019-05-23 22:43
【摘要】：目的 分析腦膿腫的感染機(jī)制、臨床表現(xiàn)、影像學(xué)特點(diǎn),探討分析腦膿腫的典型性和不典型性,對(duì)治療干預(yù)時(shí)機(jī)的把握以及不同治療方式對(duì)住院時(shí)間、預(yù)后的影響,為臨床工作在診斷和治療上提供依據(jù)及經(jīng)驗(yàn)。 方法 回顧性分析浙二醫(yī)院自2011年1月至2014年12月收治的70例腦膿腫患者臨床資料,對(duì)流行病學(xué)、發(fā)病機(jī)制、部位、臨床特征、腦脊液、影像學(xué)表現(xiàn)結(jié)合國(guó)內(nèi)外文獻(xiàn)進(jìn)行總結(jié)分析,統(tǒng)計(jì)分析不同治療方式對(duì)住院時(shí)間、預(yù)后的影響,根據(jù)自定的典型性分組納入標(biāo)準(zhǔn),分為典型組與不典型組,統(tǒng)計(jì)分析典型性與否對(duì)治療干預(yù)時(shí)機(jī)及住院時(shí)間、預(yù)后等影響。 結(jié)果 70例患者中,男48例,女22例,男性多于女性。隱源性腦膿腫26例,其次是顱腦外傷及神經(jīng)外科術(shù)后16例,耳源性16例,血源性10例,免疫功能低下2例。膿腫位置：耳源性腦膿腫均位于同側(cè)顳葉和小腦半球,顱腦外傷及神經(jīng)外科術(shù)后均位于術(shù)區(qū)及毗鄰位置。 臨床表現(xiàn)主要為頭痛48例(68.57%),發(fā)熱38例(54.29%),惡性嘔吐24例(34.29%),局灶性癥狀22例(31.43%),意識(shí)障礙20例(28.57%),頸抵抗12例(17.14%),癲癇2例,頭痛、發(fā)熱和局灶性癥狀三聯(lián)癥12例(17.14%)。 70例病例22例行腰穿腦脊液檢查,16例提示感染,其中2例淋巴細(xì)胞為主,腦脊液涂片及培養(yǎng)均陰性。6例未提示感染征象。 增強(qiáng)MRI+DWI+ADC序列均表現(xiàn)為在T2-W1和DWI上高信號(hào),ADC序列低信號(hào),TI-W1增強(qiáng)上環(huán)形強(qiáng)化,行增強(qiáng)MRI+DWI+ADC序列共43例,均表現(xiàn)典型,無(wú)誤診。未行DWI共27例,誤診2例,術(shù)前診斷為膠質(zhì)瘤。 單純抗生素治療14例,穿刺抽膿術(shù)3例,穿刺引流術(shù)37例,開(kāi)顱全切12例,腦膿腫破入腦室行腦室外引流4例。開(kāi)顱全切組住院時(shí)間為(18.36±10.46)天,穿刺吸引術(shù)組住院時(shí)間(25.89±22.43)天,P0.05,具有顯著性差異,開(kāi)顱全切組GOS評(píng)分為(4.27±1.02)分,穿刺吸引術(shù)組GOS評(píng)分為(4.33±0.93)分,P0.05,無(wú)顯著性差異；單純抗生素治療組住院時(shí)間(18.07±11.02)天,手術(shù)治療(22.49±25.64)天,P0.05,無(wú)顯著性差異,單純抗生素治療組GOS評(píng)分(4.86±0.58)分,手術(shù)治療(4.11±1.76)分,P0.05,無(wú)顯著性差異。 根據(jù)自定的典型性分組納入標(biāo)準(zhǔn),共計(jì)不典型組16例,典型組54例。典型組從入院至臨床治療干預(yù)(初始抗生素使用或手術(shù))時(shí)間間隔為(0.63±1.45)天,不典型組時(shí)間間隔為(2.00±2.14)天,P0.05,具有顯著性差異。典型組腦膿腫住院時(shí)間為(20.38±10.07)天,不典型組為(24.22±13.82)天,P0.05,有顯著差異。GOS預(yù)后評(píng)分典型組(4.25±1.58)分,不典型組(4.46±0.76)分,兩組無(wú)顯著性差異。 結(jié)論 腦膿腫位置的多樣性,感染源的不確定性,癥狀表現(xiàn)的不典型性,部分腦脊液無(wú)感染征象性,影像檢查的不完善性及不典型性可使腦膿腫誤診或延遲診斷。不典型性腦膿腫可使治療干預(yù)延遲,影響住院時(shí)間,但對(duì)預(yù)后無(wú)影響,臨床上一旦懷疑腦膿腫仍應(yīng)及時(shí)治療干預(yù),手術(shù)全切較穿刺吸引術(shù)能縮短住院時(shí)間,但對(duì)預(yù)后無(wú)影響。
[Abstract]:Objective to analyze the infection mechanism, clinical manifestations and imaging features of brain abscess, and to explore and analyze the typical and atypical nature of brain abscess, the timing of treatment and intervention, and the influence of different treatment methods on hospitalization time and prognosis. It provides the basis and experience for clinical work in diagnosis and treatment. Methods the clinical data of 70 patients with brain abscess treated in Zhejiang No. 2 Hospital from January 2011 to December 2014 were analyzed retrospectively. the epidemiological, pathogenesis, location, clinical characteristics and cerebrospinal fluid (cerebrospinal fluid) were analyzed. The imaging findings were summarized and analyzed in combination with the literature at home and abroad, and the effects of different treatment methods on hospitalization time and prognosis were statistically analyzed. According to the criteria of typical grouping, they were divided into typical group and atypical group. Statistical analysis of typical or not on the timing of treatment intervention, hospitalization time, prognosis and so on. Results among the 70 patients, there were 48 males and 22 females, and the number of males was more than that of females. There were 26 cases of cryptogenic brain abscess, followed by craniocerebral trauma and neurosurgery in 16 cases, otogenic in 16 cases, hematogenic in 10 cases and immunosuppression in 2 cases. Location of abscess: otogenic brain abscess is located in ipsilateral temporal lobe and cerebellar hemisphere, craniocerebral trauma and neurosurgery are located in the surgical area and adjacent position. The main clinical manifestations were headache in 48 cases (68.57%), fever in 38 cases (54.29%), malignant vomiting in 24 cases (34.29%), focal symptoms in 22 cases (31.43%) and disturbance of consciousness in 20 cases (28.57%). Cervical resistance was found in 12 cases (17.14%), seizures in 2 cases, headache, fever and focal symptoms in 12 cases (17.14%). Lumbar puncture cerebrospinal fluid examination was performed in 22 cases of 70 cases. 16 cases showed infection, of which 2 cases were mainly lymphocytes, cerebrospinal fluid smear and culture were negative. 6 cases did not show signs of infection. All the enhanced MRI DWI ADC sequences showed high signal intensity on T2-W1 and DWI, low signal intensity on ADC sequence and annular enhancement on TI-W1 enhancement. A total of 43 cases of enhanced MRI DWI ADC sequence were performed, all of which showed typical diagnosis. There were 27 cases without DWI, 2 cases were misdiagnosed and diagnosed as glioma before operation. 14 cases were treated with antibiotics alone, 3 cases by puncture and drainage, 37 cases by puncture drainage, 12 cases by total craniotomy, and 4 cases by outdoor drainage of brain abscess. The hospitalization time was (18.36 鹵10.46) days in the total craniotomy group and (25.89 鹵22.43) days in the puncture suction group, with significant difference. The GOS score of the total craniotomy group was (4.27 鹵1.02) days. The GOS score of puncture and aspiration group was (4.33 鹵0.93), P0.05, and there was no significant difference between the two groups. The hospitalization time of antibiotic treatment group was (18.07 鹵11.02) days, and that of surgical treatment group was (22.49 鹵25.64) days, and there was no significant difference between the two groups. The GOS score of antibiotic treatment group was (4.86 鹵0.58). There was no significant difference in surgical treatment (4.11 鹵1.76) and P0.05. According to the standard of typicality, there were 16 cases in atypical group and 54 cases in typical group. The time interval from admission to clinical treatment intervention (initial antibiotic use or operation) was (0.63 鹵1.45) days in the typical group and (2.00 鹵2.14) days in the atypical group, with significant difference between the two groups. The hospitalization time of brain abscess was (20.38 鹵10.07) days in typical group and (24.22 鹵13.82) days in atypical group, with significant difference. GOS prognostic score was (4.25 鹵1.58) in typical group and (4.46 鹵0.76) in atypical group. There was no significant difference between the two groups. Conclusion the diversity of brain abscess location, the uncertainty of infection source, the atypical manifestation of symptoms, the absence of infection sign in some cerebrospinal fluid (cerebrospinal fluid), and the imperfection and typicality of imaging examination can make the diagnosis of brain abscess misdiagnosed or delayed. Atypical brain abscess can delay the treatment intervention and affect the hospitalization time, but has no effect on the prognosis. Once the brain abscess is suspected to be treated in time, the total operation can shorten the hospitalization time, but has no effect on the prognosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1
本文編號(hào)：2484301
[Abstract]:Objective to analyze the infection mechanism, clinical manifestations and imaging features of brain abscess, and to explore and analyze the typical and atypical nature of brain abscess, the timing of treatment and intervention, and the influence of different treatment methods on hospitalization time and prognosis. It provides the basis and experience for clinical work in diagnosis and treatment. Methods the clinical data of 70 patients with brain abscess treated in Zhejiang No. 2 Hospital from January 2011 to December 2014 were analyzed retrospectively. the epidemiological, pathogenesis, location, clinical characteristics and cerebrospinal fluid (cerebrospinal fluid) were analyzed. The imaging findings were summarized and analyzed in combination with the literature at home and abroad, and the effects of different treatment methods on hospitalization time and prognosis were statistically analyzed. According to the criteria of typical grouping, they were divided into typical group and atypical group. Statistical analysis of typical or not on the timing of treatment intervention, hospitalization time, prognosis and so on. Results among the 70 patients, there were 48 males and 22 females, and the number of males was more than that of females. There were 26 cases of cryptogenic brain abscess, followed by craniocerebral trauma and neurosurgery in 16 cases, otogenic in 16 cases, hematogenic in 10 cases and immunosuppression in 2 cases. Location of abscess: otogenic brain abscess is located in ipsilateral temporal lobe and cerebellar hemisphere, craniocerebral trauma and neurosurgery are located in the surgical area and adjacent position. The main clinical manifestations were headache in 48 cases (68.57%), fever in 38 cases (54.29%), malignant vomiting in 24 cases (34.29%), focal symptoms in 22 cases (31.43%) and disturbance of consciousness in 20 cases (28.57%). Cervical resistance was found in 12 cases (17.14%), seizures in 2 cases, headache, fever and focal symptoms in 12 cases (17.14%). Lumbar puncture cerebrospinal fluid examination was performed in 22 cases of 70 cases. 16 cases showed infection, of which 2 cases were mainly lymphocytes, cerebrospinal fluid smear and culture were negative. 6 cases did not show signs of infection. All the enhanced MRI DWI ADC sequences showed high signal intensity on T2-W1 and DWI, low signal intensity on ADC sequence and annular enhancement on TI-W1 enhancement. A total of 43 cases of enhanced MRI DWI ADC sequence were performed, all of which showed typical diagnosis. There were 27 cases without DWI, 2 cases were misdiagnosed and diagnosed as glioma before operation. 14 cases were treated with antibiotics alone, 3 cases by puncture and drainage, 37 cases by puncture drainage, 12 cases by total craniotomy, and 4 cases by outdoor drainage of brain abscess. The hospitalization time was (18.36 鹵10.46) days in the total craniotomy group and (25.89 鹵22.43) days in the puncture suction group, with significant difference. The GOS score of the total craniotomy group was (4.27 鹵1.02) days. The GOS score of puncture and aspiration group was (4.33 鹵0.93), P0.05, and there was no significant difference between the two groups. The hospitalization time of antibiotic treatment group was (18.07 鹵11.02) days, and that of surgical treatment group was (22.49 鹵25.64) days, and there was no significant difference between the two groups. The GOS score of antibiotic treatment group was (4.86 鹵0.58). There was no significant difference in surgical treatment (4.11 鹵1.76) and P0.05. According to the standard of typicality, there were 16 cases in atypical group and 54 cases in typical group. The time interval from admission to clinical treatment intervention (initial antibiotic use or operation) was (0.63 鹵1.45) days in the typical group and (2.00 鹵2.14) days in the atypical group, with significant difference between the two groups. The hospitalization time of brain abscess was (20.38 鹵10.07) days in typical group and (24.22 鹵13.82) days in atypical group, with significant difference. GOS prognostic score was (4.25 鹵1.58) in typical group and (4.46 鹵0.76) in atypical group. There was no significant difference between the two groups. Conclusion the diversity of brain abscess location, the uncertainty of infection source, the atypical manifestation of symptoms, the absence of infection sign in some cerebrospinal fluid (cerebrospinal fluid), and the imperfection and typicality of imaging examination can make the diagnosis of brain abscess misdiagnosed or delayed. Atypical brain abscess can delay the treatment intervention and affect the hospitalization time, but has no effect on the prognosis. Once the brain abscess is suspected to be treated in time, the total operation can shorten the hospitalization time, but has no effect on the prognosis.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R651.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 孫虎;;顱腦外傷術(shù)后顱內(nèi)感染相關(guān)危險(xiǎn)因素分析[J];中華醫(yī)院感染學(xué)雜志;2013年01期
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