Walters B C, Hoffman H J, Hendrick E B, Humphreys R P
J Neurosurg. 1984 May;60(5):1014-21. doi: 10.3171/jns.1984.60.5.1014.
A retrospective study of the management of patients with infected cerebrospinal fluid (CSF) shunts was undertaken, covering the 20 years from 1960 to 1979, inclusive, and involving 222 patients with 267 infections. The data were analyzed with emphasis on influences surrounding treatment choice and subsequent outcome. Treatment was classified into three major categories: medical management (antibiotics alone), surgical management (antibiotics plus operative removal of the infected shunt), and no treatment (ranging from admission and observation only to shunt revision), the diagnosis of shunt infection having been missed. Results showed surgical treatment to be more efficacious than medical or no treatment, with a higher rate of initial cure, and lower morbidity and mortality rates. Also examined were the relationships among clinical presentation, infection rate, and results of specimens sent for culture, and initial treatment. The definitive nature of initial treatment was revealed to be directly proportional to the aggressiveness of microbiological investigation. This latter aspect was related to clinical presentation, with shunt malfunction being the least recognized symptom of shunt infection. Patients presenting with blocked shunts were less likely to receive therapy appropriate for infection than any other group, leading to the conclusion that shunt malfunction may be more specific to infection than heretofore believed.
我们对1960年至1979年（含）这20年间脑脊液（CSF）分流管感染患者的治疗情况进行了一项回顾性研究，涉及222例患者，共发生267次感染。分析这些数据时重点关注了影响治疗选择及后续结果的因素。治疗分为三大类：药物治疗（仅使用抗生素）、手术治疗（抗生素加手术移除感染的分流管）以及未治疗（从仅入院观察到分流管修复，其间漏诊了分流管感染）。结果显示，手术治疗比药物治疗或未治疗更有效，初始治愈率更高，发病率和死亡率更低。我们还研究了临床表现、感染率、送检培养标本结果与初始治疗之间的关系。结果表明，初始治疗的确定性与微生物学检查的积极程度直接相关。后一个方面与临床表现有关，分流管功能障碍是分流管感染最不易识别的症状。分流管堵塞的患者比其他任何组更不太可能接受针对感染的适当治疗，由此得出结论，分流管功能障碍可能比以往认为的更具感染特异性。
