摘要
目的探讨万古霉素静脉联合鞘内途径治疗开颅术后颅内感染的疗效与安全性。方法回顾分析2013年6月1日至2015年6月1日南方医科大学南方医院神经外科行开颅手术后并发颅内感染的60例患者的临床资料。根据患者给药途径分为单纯静脉注射组（25例）和静脉联合鞘内注射组（35例）。两组患者均静脉滴注盐酸万古霉素500kU、6h1次，联合三／四代头孢菌素或美罗培南；静脉联合鞘内注射组在静脉滴注的基础上，经腰大池引流或腰椎穿刺（腰穿）释放脑脊液（CSF）后缓慢注入盐酸万古霉素20mg，每日1次。比较两组患者的临床治愈率及并发症发生情况。结果静脉联合鞘内注射组治愈率明显高于单纯静脉注射组（94．3％比76．0％，χ2=4．220，P=0．040）。静脉联合鞘内注射组CSF中白细胞数下降速度明显快于单纯静脉注射组（趋于正常时间：8d比13d），且静脉联合鞘内注射组治愈时间也较单纯静脉注射组明显缩短（d：9．9±0．7比13．4±1．1，t=-2．716，P=0．009）。3例患者鞘内给药后出现神经根刺激症状，给予对症处理、减慢给药速度后缓解；两组无一例患者出现昏迷、癫痫、死亡等严重并发症。结论治疗开颅术后合并颅内感染患者时采用万古霉素静脉联合鞘内用药方法比单纯静脉用药方法更加安全有效。
Objective To explore the efficacy and safety of combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infection after craniotomy. Methods Clinical data of a total of 60 consecutive patients with intracranial infections after cranial operation admitted to Department of Neurosurgery of Nanfang Hospital of Southern Medical University from June 1st 2013 to June 1st 2015 were retrospectively analyzed. The patients were divided into two groups： intravenous injection only （n = 25） and combined intra＇~enous and intrathecal injection （n = 35）. In both groups of patients intravenously given vancomycin hydrochloride 500 kU every 6 hours as well as third or fourth generation of cephalosporins or meropenem. In combined intravenous and intrathecal injection group, in addition to 20 mg vancomycin was slowly injected via lμmbar puncture after release of cerebrospinal fluid （CSF） once a day. The clinical efficacy and complications of the two groups were compared. Results The recovery rate in the combined intravenous and intrathecal injection group was significantly higher than that in the intravenous injection only group （94.3% vs. 76.0%, ~ 2 = 4.220, P = 0.040）. Lowering of white blood cell count in combined intravenous and intrathecal injection group was significantly earlier than that of the intravenous injection only group （time to become normal： 8 days vs. 13 days）. The time of recovery in combined intravenous and intrathecal injection group was significantly shorter than that of the intravenous injection only group （days： 9.9 ＋ 0.7 vs. 13.4 ＋ 1.1, t = -2.716, P = 0.009）. There were 3 patients who experienced nerve root irritation symptoms in combined intravenous and intrathecal injection group. Symptomatic treatment was given and injection speed was slowed down for these patients. There were no severe complications, such as coma, epilepsy or death in both groups. Conclusion Combined intravenous and intrathecal injection of vancomycin could be a safe and effective therapy for intracranial infection after craniotomy.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第2期169-172,共4页
Chinese Critical Care Medicine
基金
广东省科技计划项目(2013B02180030)@@@@ Science and Technology Planning Project of Guangdong Province of China
关键词
万古霉素
鞘内注射
开颅术后
颅内感染
Vancomycin
Intrathecal injection
Post craniotomy
Intracranial infection
