评价应用分层引流技术治疗化脓性颅内感染的临床疗效与安全性。

回顾性分析中国医学科学院整形外科医院2022年10月1日至2023年10月1日收治的确诊为化脓性颅内感染的82例患者术中及术后临床资料、治疗结果和随访情况。性别、原发病种类、感染细菌种类等计数资料以例数（%）描述；分层引流手术时间、感染控制时间等计量资料采用中位数（四分位数）[M（P₂₅，P₇₅）]表示，组间比较采用Mann-Whitney U检验。

入组82例患者住院时间均超过30 d，均表现出多重耐药（MDR）菌感染特征并接受分层引流技术治疗化脓性颅内感染。患者术前脓液或脑脊液培养结果均为阳性，其中革兰阴性杆菌感染78例（95.1%），革兰阳性球菌感染11例（13.4%）。患者全身引流管数量均2根以上，最多可达6根。患者脑室系统积脓发生率为56.1%（46/82），其中侧脑室颞角引流者38例（46.3%），四脑室引流者12例（14.6%），腰大池引流者19例（23.2%）。入组患者30 d感染控制率为91.5%（75/82），感染控制时间为[15（10，21）]d。随访6个月，死亡患者4例（4.9%），新发感染者1例（1.2%）；行脑室-腹腔分流者57例（69.5%）。

本研究通过硬膜下、脑室及皮下多导管联合分层引流技术，结合动态脑脊液压力调节机制，验证了分层引流技术在有效控制跨解剖层次感染以及改善脑脊液循环障碍方面的显著效果，为化脓性颅内感染的治疗提供了创新性的解决策略。

To evaluate the clinical efficacy and safety of stratified drainage in the treatment of suppurative intracranial infection.

The clinical data, treatment outcomes and follow-up of 82 patients diagnosed with suppurative intracranial infection in the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from October 1st, 2022 to October 1st, 2023 were analyzed, retrospectively. Categorical data such as gender, type of primary disease and type of infecting bacteria were described as cases (%). Quantitative data, including layered drainage time and infection control time were expressed as medians (interquartile range) [M (P₂₅, P₇₅)], comparisons between groups were performed by Mann-Whitney U test.

All the 82 patients were hospitalized for more than 30 days, and all exhibited multidrug-resistant (MDR) bacterial infection and were treated with stratified drainage for suppurative intracranial infection. The culture results of pus or cerebrospinal fluid were positive before operation, including 78 (95.1%) cases of Gram-negative bacilli infection and 11(13.4%) cases of Gram-positive cocci infection. The number of patients’ systemic drainage tubes was more than 2, up to 6. The incidence of ventricular empyema was 56.1% (46/82), including 38 cases (46.3%) with drainage from the temporal horn of the lateral ventricle, 12 cases (14.6%) with drainage from the fourth ventricle and 19 cases (23.2%) with drainage from the lumbar cistern. The 30 day infection control rate was 91.5% (75/82) and infection control period was [15 (10, 21)] days. After 6-month follow-up, 4 (4.9%) cases died, 1 (1.2%) case had developed a new infection; 57 (69.5%) cases had undergone ventriculoperitoneal shunt procedures.

Through the subdural, intraventricular and subcutaneous multi-catheter combined with layered drainage technology, and dynamic cerebrospinal fluid pressure regulation mechanism, this study verified the significant effect of layered drainage technology in the effective control of cross anatomical level infection and improvement of cerebrospinal fluid circulation disorder, and provided innovative solutions for the treatment of suppurative intracranial infection.