神经重症患者中枢神经系统感染多黏菌素局部应用的中国专家共识(2024年版)  

Consensus of Chinese experts on topical application of polymyxin in severe central nervous system infections(2024)

作　　者：中国医师协会神经外科分会神经重症专家委员会 中国神经外科重症管理协作组 石广志[2] 冯光 Neurological Intensive Care Expert Committee of Neurosurgical Branch of Chinese Medical Association;China Neurosurgical Intensive Care Management Collaborative Group;Shi Guangzhi;Feng Guang(不详;Department of Critical Care,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China;Department of Neurosurgery,He'nan Provincial People's Hospital(People's Hospital of Zhengzhou University),Zhengzhou 450003,China)

机构地区：[1]不详 [2]首都医科大学附属北京天坛医院重症医学科,北京100070 [3]河南省人民医院(郑州大学人民医院)神经外科,郑州450003

出　　处：《中华神经医学杂志》2024年第2期109-118,共10页Chinese Journal of Neuromedicine

基　　金：河南省科技厅医学科技攻关项目(202302311183);北京市医院管理中心"扬帆"重点医学专业发展计划(ZYLX202109)。

摘　　要：神经重症患者中枢神经系统感染治疗难度大、病死率高,多重耐药革兰阴性杆菌感染占比逐年升高。多黏菌素是治疗多重耐药革兰阴性杆菌的有效药物,但其血脑屏障通过率低,静脉给药难以达到有效的药物浓度,脑室内或鞘内给药等局部应用的方式近年来越来越多地被临床采用,但缺乏相关的规范化操作指引,故本共识专家委员会围绕多黏菌素局部应用治疗中枢神经系统感染的适应证、用法用量、治疗途径等问题进行反复讨论,形成14条共识推荐意见,以期为多黏菌素中枢神经系统局部应用提供科学和切实可行的临床指导。Treatment of severe central nervous system infections in patietns with neurological severe diseases is difficult,with high mortality rate.Proportion of multidrug-resistant Gram negative bacteria has been increasing year by year.Polymyxin is an effective drug for multidrug-resistant Gram negative bacteria,but its blood-brain barrier permeability is low,making it difficult for intravenous administration to achieve effective drug concentration.Topical applications such as intracerebroventricular or intrathecal administrations have been increasingly used in clinical practice in recent years,but lack relevant standardized guidelines.Therefore,the expert committee of this consensus has repeatedly discussed the indications,dosage,and treatment routes of topical application of polymyxin in central nervous system infections,and has formed 14 consensus recommendations,with a view to provide scientific and practicable clinical guidance for standardized topical application of polymyxin in central nervous system.

关 键 词：神经重症 中枢神经系统感染 多黏菌素 鞘内给药 脑室内给药 

分 类 号：R741[医药卫生—神经病学与精神病学]