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万古霉素两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床研究
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| 篇名： | 万古霉素两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床研究 |
| TITLE： | |
| 摘要： | 目的：考察万古霉素脑室和鞘内灌注两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床疗效，以及对患者颅内压和脑脊液指标水平等的影响。方法：选取三亚市中医院2012年1月－2015年6月收治的脑外伤继发颅内感染患者共180例，按抽签法随机分为对照组和观察组，各90例，分别在侧脑室与腰大池联合持续引流的基础上给予万古霉素（20 mg溶入5 mL生理盐水中）脑室和鞘内灌注治疗，q12 h，疗程均为7 d。比较两组患者的临床疗效，感染控制时间，治疗前后体温、颅内压和脑脊液指标水平，以及不良反应发生情况。结果：治疗后，观察组患者的总有效率（95.56％）显著高于对照组（77.78％），差异有统计学意义（P＜0.05）；观察组患者的感染控制时间[（9.67±1.10）d]显著短于对照组[（11.84±1.29）d]，差异有统计学意义（P＜0.05）；两组患者的体温、颅内压、脑脊液中蛋白质和白细胞水平均较治疗前显著降低，脑脊液中葡萄糖水平较治疗前显著升高，且观察组患者上述指标均显著优于对照组，差异均有统计学意义（P＜0.05）。两组患者不良反应发生率比较，差异无统计学意义（P＞0.05）。结论：万古霉素鞘内灌注给药辅助持续引流治疗脑外伤继发颅内感染可有效加快病情康复进程，降低患者体温和颅内压，并有助于改善脑脊液相关指标，疗效优于脑室灌注给药。 |
| ABSTRACT： | OBJECTIVE： To investigate clinical efficacy of cerebroventricular perfusion and intrathecal perfusion of vancomycin assisting with continuous drainage in the treatment of intracranial infection secondary to traumatic brain injury， and its effects on cerebrospinal fluid indexes and intracranial pressure. METHODS： One hundred and eighty patients with intracranial infection secondary to traumatic brain injury selected from Sanya Hospital of TCM during Jan. 2012 to Jun. 2015 were randomly divided into control group and observation group according to lottery， with 90 cases in each group. They were given cerebroventricular perfusion and intrathecal perfusion of vancomycin （20 mg dissolved in 5 mL normal saline） in cella lateralis and lumbar cisterna respectively combined with continuous drainage， q12 h. Both groups received treatment for 7 d.Clinical efficacy， the time of infection control were compared between 2 groups as well as body temperature， intracranial pressure and cerebrospinal fluid indexes before and after treatment， and the occurrence of ADR. RESULTS： After treatment， total response rate of observation group （95.56％） was significantly higher than that of control group （77.78％）， with statistical significance （P＜0.05）. The time of infection control in observation group [（9.67±1.10）d] was significantly shorter than in control group [（11.84±1.29）d]， with statistical significance （P＜0.05）. Body temperature， intracranial pressure， cerebrospinal fluid protein and leukocyte of 2 groups were significantly lower than before treatment； cerebrospinal fluid glucose level was increased significantly compared to before treatment； above indexes of observation group were significantly better than those of control group， with statistical significance （P＜0.05）.There was no statistical significance in the incidence of ADR between 2 groups （P＞0.05）. CONCLUSIONS： The intrathecal perfusion of vancomycin assisting with continuous drainage in the treatment of intracranial infection secondary to traumatic brain injury can effectively speed up the rehabilitation process， reduce the body temperature and intracranial pressure， and is helpful to improve the relevant cerebrospinal fluid indexes. Therapeutic efficacy of it is better than that of cerebroventricular perfusion. |
| 期刊： | 2017年第28卷第5期 |
| 作者： | 田小文，蔡翠珠，赵如峰，王方，徐世双，王磊 |
| AUTHORS： | TIAN Xiaowen，CAI Cuizhu，ZHAO Rufeng，WANG Fang，XU Shishuang，WANG Lei |
| 关键字： | 万古霉素；脑室灌注；鞘内灌注；脑外伤；颅内感染；颅内压 |
| KEYWORDS： | Vancomycin； Cerebroventricular perfusion； Intrathecal perfusion； Traumatic brain injury； Intracranial infection； Intracranial pressure |
| 阅读数： | 397 次 |
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