脑脊液置换联合万古霉素与地塞米松鞘内注射治疗术后颅内感染的临床研究

Efficacy of cerebrospinal fluid volume replacement combined with intrathecal injection of vancomycin and dexamethasone for postoperative intracranial infection

目的探讨脑脊液置换联合万古霉素与地塞米松鞘内注射治疗术后颅内感染的疗效。方法2002~2012年收治67例术后颅内感染患者,均给与脑脊液置换治疗;在此基础上,25例给予静脉滴注头孢曲松治疗（对照组）,42例给予鞘内注射万古霉素和地塞米松治疗（治疗组）。结果治疗组14 d治愈率（64.3%,27/42）、20 d治愈率（83.3%,33/42）和总治愈率（100%）均明显高于对照组[（分别为20.0%,5/25;56.5%（13/25）;84.0%（21/25）;P〈0.05）。治疗组平均治愈时间[（13.21±4.52）d]较对照组[（22.51±5.74）d]显著缩短（P〈0.05）。两组脑萎缩、脑积水、神经根刺激症状等并发症发生率无统计学差异（P〉0.05）。结论脑脊液置换联合万古霉素和地塞米松联合鞘内注射治疗术后颅内感染疗效显著,实用安全。

Objective To evaluate the clinical efficacy and safety of cerebrospinal fluid volume replacement （CSFVR） combined with intrathecal injection of vancomycin and dexamethasone for postoperative intracranial infection （PII）. Methods Sixty-seven patients with PII were admitted to our hospital from 2002 to 2012. All patients received CSFVR. Forty-two patients received intrathecal injection of vancomycin and dexamethasone （group A） and 25 received systematic rocephin （group B）. Results The 14-day cure rate, the 21-day cure rate and the overall cure rate were significantly higher in group A [64.3% （27/420）, 83.3% （35/42） and 100% （42/42）, respectively] than those [20.0% （5/25）, 56.5% （13/25） and 84.0% （21/25）, respectively] in group B （P〈0.05）. The curing time was significantly shorter in group A （22.51±5.74 days） than that （13.21±4.52 days） in group B （P〈0.05）. There were no significant differences in the complication rate between group A and group B （P〉0.05）. Conclusion The CSFYR combined with intrathecal injection of vancomycin and dexamethasone is a good and safe method for treatment of patients with PII.