万古霉素单用与联合美罗培南治疗开颅术后颅内感染的疗效比较

Clinical efficacies of vancomycin combined with meropenem and single vancomycin in treatment of intracranial infections after craniotomy:a comparative study

目的在腰大池持续外引流的基础上,比较万古霉素联合美罗培南及与单用万古霉素静脉滴注治疗开颅术后颅内感染的临床效果。方法 44例开颅术后颅内感染患者随机分为治疗组和对照组,每组各22例,在腰大池持续外引流的基础上,对照组静脉滴注万古霉素1.0g,2次/d;治疗组在对照组的治疗方法,加用静脉滴注美罗培南2.0g,3次/d,对比分析治疗前后患者临床症状、体征、脑脊液生化检查结果等综合评定临床疗效。结果治疗组总有效率为95.45%,对照组总有效率为68.18%,两组比较差异有统计学意义(P<0.05);治疗组有2例出现轻度腹泻,有1例注射部位出现红肿疼痛,对照组有1例轻度腹泻,两组均未发现其他严重不良反应。结论应用万古霉素、美罗培南静脉滴注联合腰大池持续外引流术治疗颅脑术后颅内感染方法简单,安全有效。

OBJECTIVE To compare the clinical efficacies of vancomycin combined with meropenem and single vancomycin in the treatment of intracranial infections after craniotomy based on the continuous lumbar cisterna drainage.METHODS A total of 44 patients with craniotomy intracranial infections were randomly divided into the treatment group（22 cases） and the control group（22 cases）,the control group was treated with the continuous lumbar cisterna drainage,intravenous vancomycin 1.0g 2 times/d.On basis of the control group,the treatment group was treated with the intravenous infusion meropenem 2.0 g,3 times/d.The clinical symptoms and signs as well as the CSF biochemical tests results before and after the treatment were compare and analyzed,and the clinical efficacies were comprehensively assessed.RESULTS The total effective rate of the treatment group was 95.45%,68.18% of the control group,the difference was statistically significant（P0.05）.In the treatment group,there were two patients with mild diarrhea and one case with injection site swelling and pain,and in the control group,there was one case with mild diarrhea.Neither of the two groups had been detected with other serious adverse reactions.CONCLUSION The intravenous infusion of vancomycin and meropenem combined with continuous lumbar cisterna drainage is a simple,safe,and effective way to treat the intracranial infections after the craniotomy.