万古霉素两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床研究

发布时间：2018-05-05 16:11

本文选题：万古霉素 + 脑室灌注　；参考：《中国药房》2017年05期

【摘要】：目的:考察万古霉素脑室和鞘内灌注两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床疗效,以及对患者颅内压和脑脊液指标水平等的影响。方法:选取三亚市中医院2012年1月-2015年6月收治的脑外伤继发颅内感染患者共180例,按抽签法随机分为对照组和观察组,各90例,分别在侧脑室与腰大池联合持续引流的基础上给予万古霉素(20 mg溶入5 mL生理盐水中)脑室和鞘内灌注治疗,q12h,疗程均为7d。比较两组患者的临床疗效,感染控制时间,治疗前后体温、颅内压和脑脊液指标水平,以及不良反应发生情况。结果:治疗后,观察组患者的总有效率(95.56%)显著高于对照组(77.78%),差异有统计学意义(P0.05);观察组患者的感染控制时间[(9.67±1.10)d]显著短于对照组[(11.84±1.29)d],差异有统计学意义(P0.05);两组患者的体温、颅内压、脑脊液中蛋白质和白细胞水平均较治疗前显著降低,脑脊液中葡萄糖水平较治疗前显著升高,且观察组患者上述指标均显著优于对照组,差异均有统计学意义(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论:万古霉素鞘内灌注给药辅助持续引流治疗脑外伤继发颅内感染可有效加快病情康复进程,降低患者体温和颅内压,并有助于改善脑脊液相关指标,疗效优于脑室灌注给药。
[Abstract]:Objective: to investigate the clinical efficacy of vancomycin intraventricular and intrathecal infusion in the treatment of intracranial infection secondary to traumatic brain injury and its effects on intracranial pressure and cerebrospinal fluid index. Methods: a total of 180 patients with intracranial infection secondary to brain trauma were selected from January 2012 to June 2015 in Sanya Hospital of Chinese Medicine. According to the method of drawing lots, they were randomly divided into control group and observation group with 90 cases each. On the basis of continuous drainage of lateral ventricle and lumbar cistern, 20 mg vancomycin was dissolved into 5 mL normal saline. The clinical efficacy, infection control time, body temperature, intracranial pressure, cerebrospinal fluid index, and adverse reaction were compared between the two groups. Results: after treatment, the total effective rate of patients in the observation group was significantly higher than that in the control group (77.78), the difference was statistically significant (P 0.05), the infection control time of the patients in the observation group [9.67 卤1.10 days] was significantly shorter than that in the control group [11.84 卤1.29 days], the difference was statistically significant (P0.05); the body temperature, intracranial pressure, intracranial pressure of the two groups were significantly shorter than that of the control group [11.84 卤1.29 days]. The levels of protein and white blood cells in cerebrospinal fluid were significantly lower than those before treatment, and the level of glucose in cerebrospinal fluid was significantly higher than that before treatment. The above indexes in the observation group were significantly better than those in the control group, and the differences were statistically significant (P 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P 0.05). Conclusion: vancomycin intrathecal infusion and continuous drainage in the treatment of intracranial infection secondary to traumatic brain injury can effectively accelerate the recovery of the disease, reduce the body temperature and intracranial pressure of the patients, and help to improve the cerebrospinal fluid (CSF) related indexes. The therapeutic effect was better than that of intraventricular perfusion.
【作者单位】：海南省乐东黎族自治县中医院神经外科;三亚市中医院内科;解放军92474部队医院普通外科;
【分类号】：R651.15

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