鞘内注射万古霉素治疗神经外科术后颅内感染患者的疗效观察

Clinical efficacy of intrathecal injection of vancomycin in treatment of postoperative intracranial infections in neurosurgery department patients

目的探讨鞘内注射万古霉素治疗神经外科术后颅内感染患者的疗效,为其临床治疗提供参考依据。方法共纳入神经外科手术治疗后发生颅内感染患者80例,采用随机数字法平均分为A、B两组,A组患者给予鞘内注射万古霉素治疗,B组患者给予静脉滴注万古霉素治疗,对两种方法的临床疗效进行比较。结果治疗总有效率A组为92.5%、B组为75.0%,A组疗效明显优于B组,差异有统计学意义(P<0.05);住院时间A组患者(11.4±1.6)d、B组患者(23.8±2.5)d,两组差异有统计学意义(P<0.05);治疗前A组患者体温(39.7±1.2)℃、脑脊液(CSF)白细胞(89.9±32.1)×106/L与B组患者体温(39.8±1.1)℃、CSF白细胞(89.8±31.6)×106/L相比,差异无统计学意义;治疗后7dA组患者体温(37.0±0.4)℃、CSF白细胞(9.3±1.5)×106/L,B组患者体温(89.8±31.6)℃、CSF白细胞(16.5±3.3)×106/L与治疗前相比均有明显改善,且与B组患者相比,A组患者体温及CSF白细胞下降更明显,差异有统计学意义(P<0.05)。结论神经外科患者术后颅内感染采用鞘内注射万古霉素较静脉滴注有更好的临床疗效,不仅可以有效减少患者的住院时间,且可以更好地降低患者的体温及CSF白细胞水平,值得临床推广应用。

OBJECTIVE To discuss the clinical efficacy of intrathecal injection of vancomycin in treatment of postoperative intracranial infections in patients of neurosurgery department so as to guide the clinical treatment. METHODS Totally 80 cases of neurosurgery department patients with postoperative intracranial infections were enrolled in the study and were randomly divided into the group A and group B, then the group A was treated with the intrathecal injection of vancomycin, the group B was given the intravenous administration of vancomycin, and the clinical efficacy was compared between the two groups. RESULTS The total effective rate of treatment was 92.5% in the group A, 75.0% in the group B, the clinical efficacy of the group A was significantly better than that of the group B （P〈0.05） ; the length of hospitalization was （11.4±1. 6）d in the group A, （23.8±2.5） d in the group B, the difference between the two groups was statistically signi{icant~ the body temperature before the treatment was （39.7±1.2）℃ in the group A, （39.8±1.1）℃ in the group B; the counts of white blood cells in cerebral spinal fluid （CFS） was （89.9±32.1）×10^6/L in the group A, （89.8±31.6）×10^6/L in the group B, the differences were not statistically significant; seven days after the treatment, the body temperature was （37. 0 ±0.4）℃ in the group A, （89. 8±31. 6）℃ in the group B, the counts of while blood cells in CFS were （9.3±1.5）×10^6/Lin the group A] （16.5±3.3）×10^6/L in the group B, which have been significantly improved as compared with those bore the treatment; as compared with the group B, the body temperature and the counts of white blood cells in CFS of the group A showed a significant decrease, （P〈0.05）. CONCLUSION The intrathecal injection of vancomycin can achieve better therapeutic effect than the intravenous administration of vancomycin on the treatment of postoperative intracranial infections in the neurosurgery department patients, it can not only shorten the length of hospitalization but also lower the body temperature and the level of white blood cells in CFS,is worthy to be promoted in the hospital.