抗菌药物及地塞米松鞘内注射联合醒脑静注射液治疗小儿化脓性脑膜炎的疗效及对血清基质金属蛋白酶-9、可溶性B7同源体3的影响

Efficacy of intrathecal injection of antibiotics and dexamethasone combined with Xingnaojing injection in the treatment of suppurative meningitis in children and its effect on serum matrix metalloproteinase-9 and soluble B7 homologue 3

目的探讨抗菌药物及地塞米松鞘内注射治疗小儿化脓性脑膜炎的临床疗效及对血清基质金属蛋白酶(matrix metalloproteinase,MMP)-9及可溶性B7同源体3(soluble B7 homologue 3,sB7-H3)水平的影响。方法将2017年1月至2019年6月本院收治的化脓性脑膜炎患儿84例随机分为对照组及观察组,每组42例。对照组给予常规治疗及抗菌药物及地塞米松静脉用药;观察组在对照组治疗基础上给予抗菌药物及地塞米松鞘内注射,同时联合醒脑静注射液静脉滴注。比较两组疗效、病情改善时间及停药后3个月内不良反应发生情况。治疗前后测定血清降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子(tumor necrosis factor,TNF)-α、MMP-9、sB7-H3水平的变化情况。结果观察组治疗总有效率高于对照组(95.24%对83.33%,P<0.05)。观察组退热时间、颅内高压消失时间、惊厥消失时间、意识恢复时间及总住院时间均短于对照组(P<0.05)。两组PCT、CRP、TNF-α、MMP-9、sB7-H3水平较治疗前均降低,且观察组较对照组PCT、TNF-α、MMP-9、sB7-H3降低更多(P<0.05),但治疗后CRP水平两组差异无统计学意义(P>0.05)。观察组不良反应发生率低于对照组(7.14%对11.90%)。结论抗菌药物鞘内注射联合醒脑静注射液治疗小儿化脓性脑膜炎较传统治疗效果较好,且安全性较佳,可下调炎症因子及MMP-9、sB7-H3的表达,帮助患儿康复。

Objective To investigate the clinical efficacy of intrathecal injection of antibiotics and dexamethasone in the treatment of suppurative meningitis in children and its effects on the levels of serum matrix metalloproteinase(MMP)-9 and soluble B7 homologue 3(sB7-H3).Methods A total of 84 children with suppurative meningitis admitted to our hospital from January 2017 to June 2019 were randomly divided into control group and observation group,with 42 cases in each group.The control group was given routine treatment and intravenous antibiotics and dexamethasone.The observation group was given intrathecal injection of antibiotics and dexamethasone on the basis of treatment in the control group,and intravenous drip of Xingnaojing injection.The efficacy,improvement time and the incidence of adverse reactions within 3 months after drug withdrawal were compared between the two groups.Serum procalcitonin(PCT),C-reactive protein(CRP),tumor necrosis factor(TNF)-α,MMP-9 and sB7-H3 levels were measured before and after treatment.Results The total effective rate of the observation group was higher than that of the control group(95.24%vs 83.33%,P<0.05).The antipyretic time,disappearance time of intracranial hypertension,disappearance time of convulsion,recovery time of consciousness and total hospitalization time in the observation group were shorter than those in the control group(P<0.05).The levels of PCT,TNF-α,MMP-9 and sB7-H3 in both groups were lower than before treatment,and the observation group were lower than the control group(P<0.05),but there was no significant difference in the level of CRP between the two groups after treatment(P>0.05).The incidence of adverse reactions in the observation group was lower than that in the control group(7.14%vs 11.90%).Conclusion Intrathecal injection of antibiotics combined with Xingnaojing injection is more effective and safer than traditional treatment in the treatment of suppurative meningitis in children.It can reduce the expression of inflammatory factors,MMP-9 and sB7-H3,and help pediatric children recover.