美罗培南联合万古霉素双途径给药治疗开颅术后颅内感染应用效果  

Effect of meropenem combined vancomycin on treating intracranial infection after craniotomy

作　　者：杨生军[1] 张春满[1] 郝文炯[1] 

机构地区：[1]延安大学附属医院神经外科,陕西延安716000

出　　处：《临床军医杂志》2017年第8期820-823,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨美罗培南、万古霉素静脉滴注联合万古霉素鞘内给药治疗开颅术后颅内感染的应用效果。方法选取延安大学附属医院自2015年7月至2016年6月收治的63例开颅手术术后感染的患者,随机分为A组(n=31)和B组(n=32)。A组采用常规静脉滴注美罗培南和万古霉素进行治疗;B组在A组的基础上予以每日10 mg的万古霉素鞘内给药。比较两组的临床疗效,并分析治疗前、后的颅内压、脑脊液常规和血清炎性因子水平。结果 B组总疗程短于A组,痊愈率和有效率均高于A组,差异有统计学意义(P<0.05)。治疗后,两组脑脊液葡萄糖、蛋白质及pH水平变化不大,两组比较,差异无统计学意义(P>0.05);但两组颅内压和白细胞计数有降低,且B组低于A组,两组比较,差异有统计学意义(P<0.05)。治疗后,两组患者血清C反应蛋白、白细胞介素-6及肿瘤坏死因子α水平有所降低,且B组低于A组,两组比较,差异有统计学意义(P<0.05)。结论美罗培南、万古霉素静脉滴注联合10 mg万古霉素鞘内给药治疗颅内感染疗效明确,安全性高,具有一定的临床推广价值。Objective To investigate the effect of intravenous meropenem combined intratheeal vancomycin on treating intracranial infection after craniotomy. Methods A retrospective study was performed on 63 cases of patients with intracranial infection after craniotomy who were admitted from July 2015 to June 2016. Patients were randomly divided into Group A（ n = 31 ）and Group B （n = 32）. Patients in Group A were given conventional intravenous meropenem combined vaneomyein ;the others in Group B were given 10 mg intrathecal vancomycin on the base of method in Group A. The intracranial pressure, cerebrospinal fluid routine examination and serum inflammatory cytokines were analyzed before and after the treatment. Results The total course of Group B was shorter than that of Group A （P 〈 0. 05 ）. After the treatment, the glucose, protein and pH levels of cerebrospinal fluid were changed little, and there was no statistically significant difference between the two groups （P 〉 0. 05 ） ;the intracranial pressure and eerebrospinal fluid hemameba levels reduced, and the level of Group B was lower than that of Group A（ P 〉 0. 05 ）. After the treatment, the serum levels of CRP, IL-6 and TNF-α were all reduced, and the level of Group B was lower than that of Group A （ P 〈 0.05 ）. Conclusion Intravenous meropenem combining intrathecal vancomycin （10 mg）has a certain effect and security to treat intracranial infection after craniotomy, which is worth of clinical promotion.

关 键 词：美罗培南 万古霉素 鞘内给药 颅内感染 

分 类 号：R978.1[医药卫生—药品]