Brown E M
Department of Medical Microbiology, Frenchay Hospital, Bristol, UK.
J Antimicrob Chemother. 1993 Feb;31 Suppl B:49-63. doi: 10.1093/jac/31.suppl_b.49.
Attempts to reach conclusions concerning the efficacy of antimicrobial prophylaxis in neurosurgery have been frustrated by the paucity of clinical trials which cannot be invalidated by flaws in their design and/or execution. Although the data are inconclusive, the weight of evidence suggests that antibiotics probably exert a protective effect in clean, non-implant procedures, for which a first or second generation cephalosporin would be appropriate. No consensus has been reached regarding the benefits of prophylaxis to patients undergoing the implantation of a CSF shunt and surgeons will therefore need to come to a decision based on their own experiences; those who elect to give antibiotics will still be left with the problems of choosing the optimum regimen and route of administration. Nor can valid conclusions be drawn about the efficacy of prophylaxis in patients with dural fistulae; a rational and ethically supportable approach would be to withhold antibiotics and to monitor patients closely for the early signs of meningitis, instituting appropriate empirical therapy should this complication arise.
由于临床试验数量稀少，且这些试验无法因设计和/或执行中的缺陷而无效，因此试图就神经外科抗菌预防的疗效得出结论一直受挫。尽管数据尚无定论，但证据表明，抗生素可能在清洁、非植入手术中发挥保护作用，第一代或第二代头孢菌素适用于此类手术。对于接受脑脊液分流术植入的患者，预防用药的益处尚未达成共识，因此外科医生需要根据自己的经验做出决定；选择使用抗生素的医生仍将面临选择最佳治疗方案和给药途径的问题。对于硬脑膜瘘患者预防用药的疗效也无法得出有效结论；一种合理且符合伦理的方法是不使用抗生素，并密切监测患者是否出现脑膜炎的早期迹象，一旦出现这种并发症，应进行适当的经验性治疗。
