鞘内注射万古霉素并地塞米松治疗小儿难治性化脓性脑膜炎的疗效研究

发布时间：2019-07-01 11:41

【摘要】：目的观察并探讨静脉注射美罗培南基础上联合鞘内注射万古霉素并地塞米松治疗小儿难治性化脓性脑膜炎的疗效与安全性。方法将2014年6月至2015年3月青海省妇女儿童医院收治的90例难治性化脓性脑膜炎患儿依据随机数字表分为观察组(45例)和对照组(45例),对照组静脉注射美罗培南,观察组在对照组基础上加用鞘内注射万古霉素并地塞米松,治疗7d后比较两组血清炎性标志物变化及临床疗效,随访3个月,记录后遗症发生率。结果治疗7d后,观察组肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)水平下降幅度[(87.3±21.8)pg/mL、(47.9±10.7)mg/L、(348.9±67.3)pg/mL]均明显高于对照组[(61.5±18.5)pg/mL、(33.0±7.9)mg/L、(263.7±61.5)pg/mL],差异有统计学意义(P0.05)。两组临床疗效比较,差异有统计学意义(Z=2.086,P=0.037),观察组总有效率(93.3%)高于对照组(82.2%)(χ~2=2.589,P=0.108)。观察组平均治疗时间[(12.8±3.9)d]明显少于对照组[(16.7±4.7)d],差异有统计学意义(t=4.216,P0.01)。两组药物不良反应及后遗症发生率比较,差异无统计学意义(P0.05)。结论小儿难治性化脓性脑膜炎在静脉注射美罗培南基础上联合鞘内注射万古霉素并地塞米松能进一步抑制炎性反应,提高临床疗效,并且未显著增加药物不良反应。
[Abstract]:Objective to observe and evaluate the efficacy and safety of intravenous meropenem combined with intrathecal injection of vancomycin and dexamethasone in the treatment of refractory suppurative meningitis in children. Methods from June 2014 to March 2015, 90 children with refractory suppurative meningitis were randomly divided into observation group (n = 45) and control group (n = 45). Meropenem was injected intravenously into the control group. Vancomycin and dexamethasone were injected intrathecally in the observation group. The changes of serum inflammatory markers and clinical efficacy were compared between the two groups after 7 days of treatment. Record the incidence of sequelae. Results after 7 days of treatment, the level of tumor necrosis factor 伪 (TNF- 伪), C reactive protein (CRP), procalcitonin (PCT) in the observation group [(87.3 卤21.8) pg/mL, (47.9 卤10.7) mg/L, (348.9 卤67.3) pg/mL] was significantly higher than that in the control group [(61.5 卤18.5) pg/mL, (33.0 卤7.9) mg/L, (263.7 卤61.5) pg/mL]. The difference was statistically significant (P 0.05). There was significant difference between the two groups (Z 鈮，

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