万古霉素不同给药途径预防脑外伤颅内感染研究

The investigation of different antibiotics administration routes to prevent intracranial infection

目的:对术前有脑脊液漏的颅内感染高危患者,术后选用万古霉素经静脉注射或鞘内注射的方式,评价两种不同给药方式预防颅内感染的效果。方法:术前脑脊液漏的脑外伤手术患者60例,根据术后万古霉素的不同给药方式随机分成鞘内注射组和静脉注射组,每组30例,采用高效液相法测定两组脑室内脑脊液万古霉素浓度,观察两组颅内感染发生率。结果:(1)鞘内注射组脑室内脑脊液中万古霉素浓度为(mg/L):1 h:49.45±20.36,8 h:70.68±46.81,16 h:50.15±23.76;(2)静脉注射组为(mg/L):1 h:5.39±1.93,8 h:2.96±0.88,16 h:7.98±3.22;鞘内注射组各主要时间点脑室内脑脊液中万古霉素浓度明显高于静脉注射组(P均<0.01)。颅内感染发生率,鞘内注射组为3.33%,静脉注射组为20.00%,两组比较差异有统计学意义(χ2=35.81,P<0.01)。结论:鞘内注射与静脉注射万古霉素相比,在减少给药剂量的同时,提高了其在脑脊液中的浓度,降低了颅内感染的发生率,减轻了患者的经济负担。

Objective:To evaluate the effect of two vancocin administrations(intravenous and intrathecal) on preventing postoperative intracranial infection in postoperative patients.Methods: According to different routes of administration,60 patients with leakage of cerebrospinal fluid were selected,and assigned randomly into two groups(intravenous group and intrathecal group).The cerebrospinal fluid was obtained by lateral ventricle drainage tube,HPLC method was used to determine the density of vancocin in ventricular cerebrospinal fluid and the incidence of intracranial infection was observed.Results: The Vancocin densities in CSF of intrathecal group were 1 h:49.45±20.36 mg/L,8 h: 70.68±46.81 mg/L,and 16 h: 50.15±23.76 mg/L respectively;at the same time points the vancocin densities in CSF of intravenous group were 5.39 ± 1.93 mg/L,2.96 ±0.88 mg/L,and 7.98 ±3.22 mg/L.The Vancocin densities in CSF of intrathecal group were obviously higher than those of intravenous group(P<0.01).The rate of incidence of intracranial infection in intrathecal group was 3.33% and that in intravenous group was 20.00%.There was significant difference in these two groups(χ2=35.81,P<0.01).Conclution: Compared with intravenous injection,intrathecal injection of Vancocin with fewer total dose can increase its concentration in ventricle,reduce the incidence of intracranial infection and the financial burden on patients.