不同方式治疗颅脑术后颅内感染的临床疗效及安全性研究  

Clinical Efficacy and Safety of Different Administration Ways in the Treatment of Intracranial Infections after Craniotomy

作　　者：卢秀花 桑林涛[2] 

机构地区：[1]山东省临沂市中心医院临床药学,276400 [2]山东省潍坊市人民医院脑科医院,261061

出　　处：《中国全科医学》2017年第32期3996-4002,共7页Chinese General Practice

基　　金：潍坊市科学技术发展计划项目(2015WS083)

摘　　要：目的探讨静脉滴注联合鞘内注射万古霉素、美罗培南结合持续腰大池引流治疗颅脑术后颅内感染的临床疗效及安全性。方法选择2014年7月—2016年7月潍坊市人民医院神经外科收治的颅脑术后颅内感染患者93例为研究对象,采用随机数字表法分为对照组、A组和B组,每组各31例。患者均积极治疗原发病,对照组静脉滴注万古霉素+美罗培南;A组在对照组的基础上,给予腰椎穿刺并鞘内注射万古霉素+美罗培南;B组在A组的基础上,给予持续腰大池引流。治疗第7天评价临床疗效,治疗前、治疗第3、5天监测外周血白细胞计数及降钙素原水平、脑脊液白细胞计数及蛋白质含量,记录不良反应发生情况。结果对照组总有效率为77.4%(24/31),A、B组均为100.0%(31/31),A、B组总有效率高于对照组(P<0.01)。A组[(13.4±6.6)d]、B组[(10.8±3.5)d]患者临床有效治疗时间短于对照组[(22.7±7.3)d](P<0.05);B组患者临床有效治疗时间短于A组(P<0.05)。治疗前,3组患者外周血白细胞计数及降钙素原水平比较,差异均无统计学意义(P>0.05);治疗第3天,B组患者外周血白细胞计数及降钙素原水平较对照组降低(P<0.05);治疗第5天,A、B组患者外周血白细胞计数及降钙素原水平较对照组降低,B组患者外周血白细胞计数及降钙素原水平较A组降低(P<0.05)。治疗前,3组患者脑脊液白细胞计数和蛋白质含量比较,差异均无统计学意义(P>0.05);治疗第3、5天,A、B组患者脑脊液白细胞计数和蛋白质含量较对照组降低,B组患者脑脊液白细胞计数较A组降低(P<0.05)。对照组腰痛发生率为45.2%(14/31),A组为51.6%(16/31),B组16.1%(5/31),B组患者腰痛发生率低于对照组和A组(P<0.01)。3组患者均未发生严重不良反应。结论静脉滴注联合鞘内注射万古霉素、美罗培南结合持续腰大池引流治疗颅脑术后颅内感染方法简单,安全有效,疗程短,值得临床推广应用。Objective To explore the clinical efficacy and safety of intravenous and intrathecal administration of vancomycin and meropenem combined with continuous lumbar cistern drainage in the treatment of intracranial infections after craniotomy. Methods We enrolled 93 cases who developed intracranial infections after undergoing craniotomy in Department of Neurosurgery,Weifang People＇s Hospital from July 2014 to July 2016 and divided them into the control group（ 31 cases）,group A（ 31 cases） and group B（ 31 cases） by random number table. All the patients were treated positively for basic diseases,and the control group received intravenous drip of vancomycin and meropenem; group A received vancomycin and meropenem administered intravenously and intrathecally via lumbar puncture; group B received vancomycin and meropenem administered intravenously and intrathecally via lumbar puncture combined with continuous lumbar cistern drainage. The clinical efficacy was evaluated on the seventh day after treatment. The WBC and procalcitonin level in peripheral blood, WBC and protein content in CSF were detected before treatment,on the third,fifth day after treatment. And the adverse reactions during treatment were recorded. Results The control group had lower overall response rate than group A [77. 4%（ 24/31）vs. 100. 0%（ 31/31） ]（ P 0. 01） and group B [77. 4%（ 24/31） vs. 100. 0%（ 31/31） ]（ P 0. 01）. The control group needed longer duration of treatment to achieve effective response than group A [（ 22. 7 ± 7. 3） d vs.（ 13. 4 ± 6. 6） d]（ P 0. 05） and group B [（ 22. 7 ± 7. 3） d vs.（ 10. 8 ± 3. 5） d]（ P 0. 05）. Group B needed shorter duration of treatment to achieve effective response than group A（ P 0. 05）. Before treatment,the WBC and procalcitonin levels in the peripheral blood did not differ significantly among the three groups（ P 0. 05）. On the third day after treatment,the WBC and procalcitonin levels in the peripheral blood in group B were lower than those in

关 键 词：感染 神经外科手术 万古霉素 美罗培南 注射 脊髓 引流术 治疗结果 

分 类 号：R619.3[医药卫生—外科学]