万古霉素治疗耐甲氧西林革兰阳性菌颅内感染的研究

Investigation of vancocin preventing intracranial infection caused by drug-resistan meticillin Gram-positive bacteria

目的比较万古霉素治疗术后耐甲氧西林革兰阳性菌所致颅内感染不同的给药途径,评价其疗效与安全性。方法对颅脑手术后并发甲氧西林耐药革兰阳性菌性颅内感染患者56例,分为3组:(1)静脉给药组:稳可信500mg静滴,q12h;(2)鞘内给药组:通过鞘内注入稳可信0.3mg/(kg·d)+地塞米松1mg,鞘内注射,q12h;(3)静脉+鞘内给药组:按以上两种方法联合给药。综合临床症状、体征和脑脊液的转归情况进行评估。结果静脉给药组、鞘内给药组、静脉和鞘内给药组,治愈率分别为26.7%、60.0%和61.9%;细菌清除率分别86.7%、100%和100%,疗程分别为22.8d,15.2d和11.5d。结论万古霉素对术后甲氧西林耐药革兰阳性菌所致颅内感染疗效确切,鞘内给药安全性好,不良反应少,值得推荐在神经外科的应用。

Objective To evaluate the effect and safety of different vancocin administrations on preventing postoperative intracranial infection caused by drug resistan meticillin Gram positive bacteria. Methods According to different routes of administration, the intracranial infection patients following craniocerebral operations were randomly assigned into three groups： （1）intravenous group：the patients were treated with intravenous drip of 500 mg vancocin at the interval of 12 h;（2）intrathecal group：the patients were treated with intrathecal injection 0.3 mg/（kg · d） vancocin and 1 mg dexamethasone at the interval of 12 h; （3）intravous and intrathecal group： the patients were given two administrations above. We evaluated the three groups according to clinical symptoms,signs and the cerebrospinal fluid. Results The recovery rates of intravenous group and intrathecal group were 26.7%,60.0%. The intravenous and intrathecal group was 61.9%. The clearances of three groups were 86.7% in intravenous group,100% in intrathecal group and 100% in intravenous and intrathecal group. The courses of treatment were 22.8 days in intravenous group,15.2 days in intrathecal group and the recovery days in the intravenous and intrathecal group were 11.5 days. Conclusion Intrathecal administration of vancocin is effective and safe in the treatment of intracranial infec tions following craniocerebral operations.