Clinic Study Of The Treatment For The Neurosurgical Intracraniocerebral Infection By Intrathecal Injection With Antibiotic

Objective:To discuss how to prevent intracranial infection after craniotomy,the Traumatic brain injury patients with fractures of the skull base cerebrospinal fluid leakage(intracranial infection in high-risk patients).Methods:Select 60 operative patients with leakage of cerebrospinal fluid randomly,in Department of neurosurgery of The NO.101 Hospital of PLA,from October 2007 to October 2008,and grouping two blocks averagely(intravenous block and intrathecal block) according to different administration routes after operation.All patients were punctured the intraventricular and indwelled drainage tubes during operations.The intravenous block patients with intravenous 0.5g vancomycin dissolved in 100mL of Health concentration of 0.9%saline- hydrochloride twice daily. In the first day of intrathecal block Patients were punctured the lumber and injected 5mL concentration 5g/L of vancomycin hydrochloride slow to the subarachnoid after drainage of cerebrospinal fluid 40mL every other day.Two groups of patients retained cerebrospinal fluid from the ventricular drainage at lumbar puncture after15 minutes,30 minutes, 1,2,4,8 and 16 hours.All of the retained cerebrospinal fluid were rapidly centrifuged,then detected the Vanconcin density and biochemical indicators. Results:The mainly Vanconcin density in CSF in intrathecal group were 1h:49.45±20.36 mg/L,8h:70.68±46.81 mg/L,16h:50.15±23.76 mg/L, at the same time point the Vanconcin density in CSF intravenous groups was 5.39±1.93 mg/L,2.96±0.88 mg/L,and 7.98±3.22 mg/L.The Vanconcin density in CSF in intrathecal group obviously higher than in intravenous groups.(p＜0.01) The rate of incidence of intracranial infection in intrathecal group was 3.33%and the intravenous group was20.00%.Comparing the two groups were significantly different(X 2=35.81,p＜0.01).The daily change of white blood cell count in cerebrospinal fluid of the two blocks exist difference(F=107.34,p=0.00), and the change of white blood cell count exist difference cell count in cerebrospinal fluid between blocks(q=-7.85,p=0.00).The daily change of protein content in cerebrospinal fluid of the two blocks exist difference(F=139.72,p=0.00),and the change of protein content exist difference cell count in cerebrospinal fluid between blocks(q=-9.36, p=0.00).The daily change of glucose content in cerebrospinal fluid of the two blocks exist difference(F=97.37,P=0.00),but the change of glucose content exist difference cell count in cerebrospinal fluid between blocks (q=-7.85,p=0.00),there was no statistical significance.Conclusion:Comparing with intravenous injection,intrathecal injections with Vanconcin can increase its concentration in ventricle while reducing dose,reduce the incidence of intravenous injection and reduce the financial burden on patients.