治疗效果
多年来,脑脓肿患者的结局已经改善。总体死亡率<13%,永久轻偏瘫和长期癫痫发生率均<50%。[49]Hall WA. Cerebral infectious processes. In: Loftus CM (ed): Neurosurgical emergencies. Park Ridge, IL: American Association of Neurological Surgeons Publications; 1994:164-82. 主要预后因素为患者就诊时的神经功能状态。 早期诊断和及时治疗与治疗效果改善相关。[50]Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. 2007 Jan;26(1):1-11.http://www.ncbi.nlm.nih.gov/pubmed/17180609?tool=bestpractice.com[51]Kao PT, Tseng HK, Liu CP, et al. Brain abscess: clinical analysis of 53 cases. J Microbiol Immunol Infect. 2003 Jun;36(2):129-36.http://www.ncbi.nlm.nih.gov/pubmed/12886965?tool=bestpractice.com 与结局不良相关的其他因素包括脑室破裂、长期使用皮质类固醇、存在发绀型心脏病、免疫功能受损状态以及识别出的病原体为星状诺卡氏菌或福氏耐格里阿米巴。[48]Mampalam TJ, Rosenblum ML. Trends in the management of bacterial brain abscesses: a review of 102 cases over 17 years. Neurosurgery. 1988 Oct;23(4):451-8.http://www.ncbi.nlm.nih.gov/pubmed/3200375?tool=bestpractice.com[52]Song L, Guo F, Zhang W, et al. Clinical features and outcome analysis of 90 cases with brain abscess in central China. Neurol Sci. 2008 Dec;29(6):425-30.http://www.ncbi.nlm.nih.gov/pubmed/19002652?tool=bestpractice.com[53]Takeshita M, Kagawa M, Izawa M, et al. Current treatment strategies and factors influencing outcome in patients with bacterial brain abscess. Acta Neurochir (Wien). 1998;140(12):1263-70.http://www.ncbi.nlm.nih.gov/pubmed/9932127?tool=bestpractice.com[54]Zakaria A, Elwatidy S, Elgamal E. Nocardia brain abscess: severe CNS infection that needs aggressive management; case report. Acta Neurochir (Wien). 2008 Oct;150(10):1097-101.http://www.ncbi.nlm.nih.gov/pubmed/18773137?tool=bestpractice.com 紫绀型心脏病患儿和新生儿发生脑脓肿时存在较高的认知功能降低风险。[1]Renier D, Flandin C, Hirsch E, et al. Brain abscesses in neonates: a study of 30 cases. J Neurosurg. 1988 Dec;69(6):877-82.http://www.ncbi.nlm.nih.gov/pubmed/3057126?tool=bestpractice.com