脑室外引流术后颅内感染经颅内给药的临床研究

Clinical study on the treatment with intrathecal therapy for intracranial infections after external ventricular drainage

目的探讨脑室外引流术后颅内感染经颅内给药的方式及临床疗效。方法 52例脑室外引流术后颅内感染患者均采用万古霉素治疗,根据给药方式分为3组:A组15例采用静脉给药,B组31例采用静脉给药+经脑室外引流管给药,C组6例行双侧脑室外持续灌洗引流,观察给药的方式、剂量及疗程与临床疗效的关系。结果 A组、B组、C组治愈率分别为33%,77%和83%,其给药总量和脑脊液中白细胞计数、蛋白质、糖和氯化物定量、体温、颅内压等颅内感染监测指标之间均呈负相关。有4例出现肾功能不全,4例出现腹泻等症状。结论万古霉素在静脉给药基础上经颅内给药为治疗脑室外引流术后颅内感染提供了一种相对安全、有效、简单、经济的方法。

Objective It is to explore intrathecal medication and its clinical efficacy on intracranial infection after external ventricular drainage.Methods 52 cases of patients with intracranial infection after external ventricular drainage were treated with vancomycin.They were divided into 3 groups according to medication： group A 15 cases using vein medication,group B 31 cases using vein medication＋ external ventricular drainage,group C 6 cases using both side external ventricular lavage.The relationships between clinical curative effect and medication,dosage and treatment course were observed.Results The recovery rates in group A,group B and group C were 33%,77% and 83%respectively.There was a negative relativity between the general doses of intrathecal vancomycin and monitoring parameters of intracranial infection such as WBC counts,contents of protein,glucose and cyanides in cerebrospinal fluid,temperature and intracranial pressure.There were 4 cases with kidney insufficiency and 4 cases with diarrhea.Conclusion Vancomycin given by intrathecal medication on the basis of vein medication is a relatively safety,simple,economic method for treating intracranial infections.