70例脑脓肿临床分析
发布时间：2019-05-23 22:43
【摘要】：目的 分析脑脓肿的感染机制、临床表现、影像学特点,探讨分析脑脓肿的典型性和不典型性,对治疗干预时机的把握以及不同治疗方式对住院时间、预后的影响,为临床工作在诊断和治疗上提供依据及经验。 方法 回顾性分析浙二医院自2011年1月至2014年12月收治的70例脑脓肿患者临床资料,对流行病学、发病机制、部位、临床特征、脑脊液、影像学表现结合国内外文献进行总结分析,统计分析不同治疗方式对住院时间、预后的影响,根据自定的典型性分组纳入标准,分为典型组与不典型组,统计分析典型性与否对治疗干预时机及住院时间、预后等影响。 结果 70例患者中,男48例,女22例,男性多于女性。隐源性脑脓肿26例,其次是颅脑外伤及神经外科术后16例,耳源性16例,血源性10例,免疫功能低下2例。脓肿位置：耳源性脑脓肿均位于同侧颞叶和小脑半球,颅脑外伤及神经外科术后均位于术区及毗邻位置。 临床表现主要为头痛48例(68.57%),发热38例(54.29%),恶性呕吐24例(34.29%),局灶性症状22例(31.43%),意识障碍20例(28.57%),颈抵抗12例(17.14%),癫痫2例,头痛、发热和局灶性症状三联症12例(17.14%)。 70例病例22例行腰穿脑脊液检查,16例提示感染,其中2例淋巴细胞为主,脑脊液涂片及培养均阴性。6例未提示感染征象。 增强MRI+DWI+ADC序列均表现为在T2-W1和DWI上高信号,ADC序列低信号,TI-W1增强上环形强化,行增强MRI+DWI+ADC序列共43例,均表现典型,无误诊。未行DWI共27例,误诊2例,术前诊断为胶质瘤。 单纯抗生素治疗14例,穿刺抽脓术3例,穿刺引流术37例,开颅全切12例,脑脓肿破入脑室行脑室外引流4例。开颅全切组住院时间为(18.36±10.46)天,穿刺吸引术组住院时间(25.89±22.43)天,P0.05,具有显著性差异,开颅全切组GOS评分为(4.27±1.02)分,穿刺吸引术组GOS评分为(4.33±0.93)分,P0.05,无显著性差异；单纯抗生素治疗组住院时间(18.07±11.02)天,手术治疗(22.49±25.64)天,P0.05,无显著性差异,单纯抗生素治疗组GOS评分(4.86±0.58)分,手术治疗(4.11±1.76)分,P0.05,无显著性差异。 根据自定的典型性分组纳入标准,共计不典型组16例,典型组54例。典型组从入院至临床治疗干预(初始抗生素使用或手术)时间间隔为(0.63±1.45)天,不典型组时间间隔为(2.00±2.14)天,P0.05,具有显著性差异。典型组脑脓肿住院时间为(20.38±10.07)天,不典型组为(24.22±13.82)天,P0.05,有显著差异。GOS预后评分典型组(4.25±1.58)分,不典型组(4.46±0.76)分,两组无显著性差异。 结论 脑脓肿位置的多样性,感染源的不确定性,症状表现的不典型性,部分脑脊液无感染征象性,影像检查的不完善性及不典型性可使脑脓肿误诊或延迟诊断。不典型性脑脓肿可使治疗干预延迟,影响住院时间,但对预后无影响,临床上一旦怀疑脑脓肿仍应及时治疗干预,手术全切较穿刺吸引术能缩短住院时间,但对预后无影响。
[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 卤10.46) days in the total craniotomy group and (25.89 卤22.43) days in the puncture suction group, with significant difference. The GOS score of the total craniotomy group was (4.27 卤1.02) days. The GOS score of puncture and aspiration group was (4.33 卤0.93), P0.05, and there was no significant difference between the two groups. The hospitalization time of antibiotic treatment group was (18.07 卤11.02) days, and that of surgical treatment group was (22.49 卤25.64) days, and there was no significant difference between the two groups. The GOS score of antibiotic treatment group was (4.86 卤0.58). There was no significant difference in surgical treatment (4.11 卤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 卤1.45) days in the typical group and (2.00 卤2.14) days in the atypical group, with significant difference between the two groups. The hospitalization time of brain abscess was (20.38 卤10.07) days in typical group and (24.22 卤13.82) days in atypical group, with significant difference. GOS prognostic score was (4.25 卤1.58) in typical group and (4.46 卤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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1
本文编号：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 卤10.46) days in the total craniotomy group and (25.89 卤22.43) days in the puncture suction group, with significant difference. The GOS score of the total craniotomy group was (4.27 卤1.02) days. The GOS score of puncture and aspiration group was (4.33 卤0.93), P0.05, and there was no significant difference between the two groups. The hospitalization time of antibiotic treatment group was (18.07 卤11.02) days, and that of surgical treatment group was (22.49 卤25.64) days, and there was no significant difference between the two groups. The GOS score of antibiotic treatment group was (4.86 卤0.58). There was no significant difference in surgical treatment (4.11 卤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 卤1.45) days in the typical group and (2.00 卤2.14) days in the atypical group, with significant difference between the two groups. The hospitalization time of brain abscess was (20.38 卤10.07) days in typical group and (24.22 卤13.82) days in atypical group, with significant difference. GOS prognostic score was (4.25 卤1.58) in typical group and (4.46 卤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.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1
【参考文献】
相关期刊论文 前1条
1 孙虎;;颅脑外伤术后颅内感染相关危险因素分析[J];中华医院感染学杂志;2013年01期
，本文编号：2484301
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