鞘内注射万古霉素对颅内感染患者脑脊液生化指标及外周血感染指标的影响  

Influence of intrathecal injection of vancomycin on cerebrospinal fluid biochemical indexes and peripheral blood infection indexes of patients with intracranial infections

作　　者：陈颖[1] 马星海[1] 王衍刚[2] CHEN Ying;MA Xing-hai;WANG Yan-gang(Jiaozuo People's Hospital,Jiaozuo,Henan 454000,China)

机构地区：[1]焦作市人民医院国家药物临床试验机构,河南焦作454000 [2]焦作市人民医院神经重症,河南焦作454000

出　　处：《中华医院感染学杂志》2025年第1期80-85,共6页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关计划项目(SBGJ202102217)。

摘　　要：目的基于症状控制、脑脊液生化指标及外周血感染指标等分析鞘内注射万古霉素在颅内感染治疗中的应用效果,为临床优化治疗方案提供参考。方法回顾性分析焦作市人民医院2021年1月-2023年10月收治的颅内感染患者的临床资料,按照患者的治疗方案不同分别纳入对照组和研究组,每组40例,对照组常规给予注射用盐酸万古霉素和美罗培南静脉滴注治疗,研究组在对照组的基础上给予万古霉素鞘内注射治疗,两组均治疗1周,比较两组治疗后的临床疗效、症状控制情况、住院时间;分析两组治疗前后脑脊液常规及生化指标水平、神经功能缺损情况、外周血感染指标水平;观察两组治疗期间不良反应发生情况。结果80例患者脑脊液细菌培养阳性率为17.50%,共检出菌株15株,以表皮葡萄球菌检出最多(4株,占26.67%);治疗1周后研究组总有效率(95.00%)较对照组(77.50%)更高(χ^(2)=5.165,P=0.023);与对照组比较,研究组体温恢复正常及住院时间更短[(2.87±0.25)d、(31.25±3.25)d](P<0.05)。两组治疗1周后的脑脊液中有核细胞数、脑脊液蛋白、外周血白细胞介素-6(IL-6)、白细胞(WBC)、C-反应蛋白(CRP)水平及美国国立卫生研究院卒中量表(NIHSS)评分较治疗前降低(P<0.05),研究组[(12.75±2.12)×10^(6)/L、(304.65±26.12)mg/L、(8.71±0.65)pg/ml、(3.97±0.22)×10^(9)/L、(6.21±0.37)mg/L、(7.56±1.22)分]低于对照组(P<0.05);脑脊液中葡萄糖水平升高(P<0.05),研究组[(4.40±0.72)mmol/L]高于对照组(P<0.05)。治疗期间两组总不良反应发生率比较,差异无统计学意义。结论鞘内注射万古霉素可有效调节颅内感染患者脑脊液生化指标及外周血感染指标水平,减轻炎症及神经功能缺损程度,控制症状,疗效显著,安全性良好。OBJECTIVE To observe the effect of intrathecal injection of vancomycin on treatment of patients with intracranial infection based on control of symptoms,cerebrospinal fluid(CSF)biochemical indexes and peripheral blood infection indexes so as to provide bases for optimizing clinical treatment programs.METHODS The clinical data were collected from the patients with intracranial infections who were treated in Jiaozuo People's Hospital from Jan.2021 to Oct.2023 and were retrospectively analyzed.The enrolled patients were divided into the control group and study group,with 40 cases in each group.The control group was given conventional intravenous drip of vancomycin hydrochloride and meropenem injection,while the study group was given additional intrathecal injection of vancomycin on basis of the treatment of the control group,both groups were treated for 1 week.The clinical curative effect,control status of symptoms,and length of hospital stay were observed and compared between the two groups;the CSF routine and biochemical indexes,status of neurologic impairment,and peripheral blood infection indexes were observed and compared between the two groups before and after the treatment;the incidence of adverse reactions was observed and compared between the two groups during the treatment period.RESULTS The positive rate of bacterial culture of CSF was 17.50%for the 80 patients.Totally 15 strains of pathogens were isolated,4(26.67%)of which were Staphylococcus epidermidis.The total effective rate of the study group was 95.00%after the treatment for 1 week,higher than 77.50%of the control group(χ^(2)=5.165,P=0.023).The time period of body temperature returning to normal and length of hospital stay of the study group were respectively(2.87±0.25)days and(31.25±3.25)days,shorter than those of the control group(P<0.05).The levels of CSF karyocytes,CSF proteins,peripheral blood interleukin-6(IL-6),white blood cell(WBC)and C-reactive protein(CRP)as well as national institutes of health stroke scale(NIHSS)score of the two grou

关 键 词：颅内感染 万古霉素 鞘内注射 症状控制 感染指标 神经功能 疗效 

分 类 号：R651.1[医药卫生—外科学]