【作者】 孙超；

【导师】 鲁质成；

【作者基本信息】 吉林大学 ， 临床医学， 2008， 硕士

【摘要】 目的:评价鞘内注射万古霉素治疗开颅术后颅内感染的临床疗效与安全性。方法:回顾性分析2年来在我院治疗的开颅术后并发颅内感染患者33例,其中采用鞘内注射万古霉素18例,单纯应用抗生素静脉用药15例,对比两者间在临床疗效、感染控制天数及费用的差异,并判断万古霉素对颅内感染致病菌的敏感性,鞘内用药量和感染相关指标的相关性,及其中枢神经系统毒副反应。结果:万古霉素对颅内感染致病菌的敏感比例为9/9(100%),治疗组18例患者中痊愈16例(88.9%),显效1例(5.6%),进步0例,无效1例(5.6%),颅内感染痊愈(显效)时间平均8天,花费18956.59元。对照组15例中痊愈8例(53.3%),显效4例(26.7%),进步1例(6.7%),无效2例(13.3%),其中死亡1例(6.7%),颅内感染痊愈(显效)时间平均24天,花费25481.38元。治疗组总体疗效好于对照组(u=2.15,P<0.05),并且节省用药时间和用药费用(P<0.05)。万古霉素鞘注后,患者颅内感染迅速得到控制,在鞘内给药3-5天后脑脊液中白细胞数、蛋白含量及颅内压明显下降,糖含量明显上升。鞘注药物总量和脑脊液中白细胞计数、糖定量、蛋白含量,均呈显著的相关性(r=0.539,r=-0.594,r=0.551,P<0.05)。仅1例患者出现神经根刺激症状,并很快恢复。结论:万古霉素对大多数颅内感染的致病菌敏感,临床疗效显著,减少住院时间,节省住院费用,无明显CNS毒性作用。更多还原

【Abstract】 Objective: To evaluate the clinical efficacy and safety of intrathecal Vancomycin in the treatment of intracranial infection after craniotomy.Methods: A retrospective study was made to 33 cases of intracranial infection after craniotomy in recent 2 years, 18 cases treated with intrathecal Vancomycin were divided into treatment group, and 15 cases treated with intravenous antibiotics were divided into control group. Compared the clinical efficacy, the period and cost spent to control the infection, and evaluated the sensitivity of Vancomycin against the germs which lead to the intracranial infections, the relations of intrathecal doses with therapeutic period and the CNS toxicity effect were also considered.Results: The sensitivity ratio of Vancomycin against etiologic agent in intracranial infections was 9 in 9(100%). In the treatment team, 16 cases were healed completely, 1 case was excellenced, 1 failed, while in control team, 8 cases were healed completely and 4 cases were excellenced, 1 was improved partly, 2 failed in which 1 died. Meanwhile the time of therapy was 16 days shorter after intrathecal Vancomycin, and the costs were about RMB6500 less for the treatment group. The clinical signs and symptoms of intracranial infection could be improved rapidly after intrathecal vancomycin administration. There was a relativity between the general doses of Vancomycin and monitoring parameters of intracranial infection such as WBC counts of CSF, glucose and protein value of CSF, (r=0.539,r=-0.594 r=0.551, P<0.05). Only 1 cases showed moderate CNS neurotoxic effects, and recovered in short time.Conclusion: Most of etiologic agents of intracranial infections are susceptible to Vancomycin, it showed perfect clinical efficacy and would shorten the costs and days for the control of infection, also no apparent neurotoxic effects are observed.更多还原