万古霉素治疗术后耐甲氧西林革兰阳性菌致颅内感染的疗效  

Efficacy and safety of vancomycin in treatment of intracranial infections caused by methicillin-resistant gram-positive bacteria

作　　者：邹积典[1] 郭庆雷[1] 侯英芳[1] 宁同波[1] 肖华明[1] 田伟[1] 

机构地区：[1]威海市文登中心医院神经外科,山东文登264400

出　　处：《中华医院感染学杂志》2013年第12期2983-2985,共3页Chinese Journal of Nosocomiology

摘　　要：目的通过万古霉素不同给药方式治疗术后耐甲氧西林革兰阳性菌致颅内感染的比较,评价其疗效和安全性。方法将颅脑术后耐甲氧西林革兰阳性菌致颅内感染患者72例,随机分为3组:A组静脉滴注万古霉素;B组鞘内给药万古霉素和地塞米松;C组按A、B组方法联合用药,汇总患者症状体征及脑脊液生化分析评价3种不同给药方式的疗效相关性。结果 A组总有效率79.2%显著低于B组100.0%、C组100.0%;治疗前、后颅内压A组为(253.1±33.2)、(134.5±27.8)mm H2O,B组为(260.1±25.5)、(116.5±27.8)mm H2O,C组为(260.1±25.5)、(102.7±22.3)mm H2O;治疗前、后血白细胞数A组为(27.8±5.8)、(8.8±3.3)×109/L,B组为(29.2±8.8)、(6.3±7.4)×109/L,C组为(28.5±4.4)、(6.2±6.3)×109/L,3组在颅内压、血白细胞数等方面依次减低,组间比较差异有统计学意义(P<0.05);而3组治疗前后脑脊液氯化物依次升高,A组为(88.2±2.3)、(118.4±3.3)mmol/L,B组为(89.3±3.1)、(125.7±4.5)mmol/L,C组为(84.7±7.3)、(128.5±6.5)mmol/L,差异均有统计学意义(P<0.05);组间的临床有效治疗时间依次缩短,C组时间最短;A组中有2例出现不良反应,其余两组未有出现。结论万古霉素鞘内给药治疗耐甲氧西林革兰阳性菌致颅内感染效果显著,安全性高、不良反应较少。OBJECTIVE To evaluate the efficacy and safety of different vancomycin administrations in the treatment of intracranial infections caused by methicillin-resistant gram-positive bacteria. METHODS A total of 72 patients with intracranial infection after cranioeerebral operations were divided into three groups randomly, the group A was administrated by vancomycin, the group B was administrated by intrathecal vancomycin and dexamethasone, and the group C was administrated by the combination with the group A and the group B. The efficacy of adminis- trations was evaluated by summarizing the symptoms, signs and cerebrospinal fluid. RESULTS The total effective rate of the group A was 79.2%, significantly lower than 100.0M of the group B and 100.0% of the group A% the intracranial pressure before the treatment was（253.1±33.2）mm H20 in the group A, （260.1±25.5）mm H2O in the group B, and （260.1±25.5） mm H20 in the group C; the intracranial pressure after the treatment was （134.5 ±27.8）mm H2O in the group A, （116.5±27.8）mm H20 in the group B, and （102.7±22.3）mmH2O in the group C; the blood leukocyte number before the treatment was （27.8 ± 5.8） ×10^9/L in the group A, （29.2 ± 8.8）×10^9/L in the group B, and （260. 1 ± 25.5） × 10^9/L in the group C; the blood leukocyte number after the treatment was （8.8±3.3） × 10^9/L in the group A, （6.3±7.4） ×10^9/L in the group B, and （6.2±6.3） × 10^9/L in the group C, the difference in the intracranial pressure or the blood leukocyte number between the three groups was statistically significant （P〈0.05）. The level of chlorides of cerebrospinal fluid before the treatment was（88.2 ±2.3）mmol/L in the group A, （89.3±3.1）mmol/L in the group B, and （84.7±7.3）mmol/L in the group C; the level of chlorides of cerebrospinal fluid after the treatment was （118.4±3.3）mmol/L in the group A, （125.7±4.5）mmol/L in the group B, and（128.5±6.5）mmol/L in the group C, showing an upward trend, the differ- ence wa

关 键 词：万古霉素 耐甲氧西林革兰阳性菌 颅内感染 

分 类 号：R978.1[医药卫生—药品]