鞘内注射抗生素与静脉滴注应用抗生素治疗重型颅脑损伤继发颅内感染的临床疗效比较

Clinical Effect of Intrathecal Injection of Antibiotics and Intravenous Infusion of Antibiotics for the Treatment of Intracranial Infection Secondary to Severe Intracranial Injury

目的比较鞘内注射抗生素与静脉滴注应用抗生素治疗重型颅脑损伤继发颅内感染的临床效果。方法对2015年1月至2016年2月海南省农垦总医院收治的76例重型颅脑损伤继发颅内感染患者进行前瞻性分析,采用随机数字法分为对照组和观察组,每组38例。对照组静脉滴注万古霉素5 mg与地塞米松2~3 mg治疗,每日1次;观察组采用鞘内注射万古霉素5 mg与地塞米松2~3 mg治疗,每日1次。比较两组患者的白细胞计数、脑脊液蛋白水平、退热时间、白细胞计数正常时间、治疗时间及临床疗效。结果观察组患者用药总有效率与对照组比较差异无统计学意义(P>0.05);治疗24 h后,两组白细胞计数及脑脊液蛋白水平均较治疗前显著降低(P<0.01),且两组白细胞计数及脑脊液蛋白水平比较差异无统计学意义(P>0.05);观察组退热时间、白细胞计数恢复正常时间及治疗时间均短于对照组[(3.26±1.02)d比(5.12±1.68)d、(4.19±1.05)d比(8.34±2.28)d、(5.46±1.42)d比(12.67±3.76)d](P<0.01)。结论重型颅脑损伤继发颅内感染患者采取鞘内注射抗生素治疗的临床疗效显著,治疗时间短,可促进患者康复。

Objective To investigate the clinical effects of intrathecal injection of antibiotics and systemic antibiotics alone in the treatment of secondary intracranial infections of severe brain injury. Methods A prospective analysis was performed on 76 patients with intracranial infection secondary to severe craniocerebral trauma who agreed to participate in this study in Hainan Provincial Reclamation General Hospital from Jan.2015 to Feb.2016,and were divided into two groups using a random number table method,38 cases each.The control group was given vancomycin 5 mg and dexamethasone 2-3 mg by intravenous infusion once per day,while the observation group was treated with intrathecal injection of vancomycin 5 mg and dexamethasone 2-3 mg,once per day.The white blood cell count,cerebrospinal fluid protein level,the time of fever recession ,the time of white blood cell count returning normal state,treatment time and clinical efficacy of the two groups were compared. Results There was no statistically significant difference in the total effective rate beween the observation group and the control group（ P 〉0.05）.At 24 hours after treatment,the white blood cell count and cerebrospinal fluid protein levels were significantly lower than those of before treatment（ P 〈0.01）;there was no significant difference between the two groups（ P 〉 0.05）.The fever recession time,white cell returning normal state time and treatment time of the observation group were shorter than those of the control group[（3.26±1.02） d vs （5.12±1.68） d,（4.19±1.05） d vs （8.34±2.28） d,（ 5.46± 1.42） d vs （12.67±3.76） d]（ P 〈0.01）. Conclusion The clinical effect of intrathecal injection of antibiotics has significant clinical effect for the treatment of intracranial infection secondary to severe craniocerebral injury,which can shorten the treatment time and promote the rehabilitation of the patients.