万古霉素鞘内注射联合腰大池持续引流在重症颅脑损伤术后颅内感染患者中的应用效果

Effect of Intrathecal Injection of Vancomycin Combined with Continuous Drainage of Lumbar Cistern in Patients with Intracranial Infection after Severe Traumatic Brain Injury

目的 :探讨万古霉素鞘内注射联合腰大池持续引流在重症颅脑损伤(Severe traumatic brain injury,STBI)术后颅内感染患者中应用效果。方法:选取2015年5月—2017年6月我院收治的89例重症颅脑损伤术后颅内感染患者,按照治疗方案的不同分为两组,对照组44例经鞘内注射万古霉素(10 mg+5 mL氯化钠注射液,qd)治疗,观察组45例给予万古霉素鞘内注射(同对照组)+腰大池持续引流治疗,比较两组治疗效果及治疗前后颅内压变化及脑脊液各指标变化情况。结果 :观察组治疗总有效率较对照组高,差异有统计学意义(P <0.05);治疗2周后观察组颅内压低于对照组,差异有统计学意义(P <0.05);治疗2周后观察组脑脊液中白细胞计数及蛋白质含量均低于对照组,葡萄糖含量高于对照组,差异有统计学意义(P <0.05)。结论 :万古霉素鞘内注射配合腰大池持续引流治疗STBI术后颅内感染的疗效确切,可降低颅内压,改善脑脊液指标,值得推广应用。

Objective: To investigate the effect of intrathecal injection of vancomycin combined with continuous drainage of lumbar cistern in the patients with intracranial infection after severe traumatic brain injury(STBI). Methods: 89 patients with intracranial infection after severe traumatic brain injury admitted to our hospital from May 2015 to June 2017 were divided into two groups according to different treatment options. 44 patients in the control group were treated by intrathecal injection of vancomycin(10 mg + 5 mL sodium chloride injection, qd), and 45 patients in the observation group were given intrathecal injection of vancomycin(10 mg + 5 mL sodium chloride injection, qd) combined with continuous drainage of lumbar cistern. The treatment effect, changes in intracranial pressure before and after treatment and changes in various indexes of cerebrospinal fluid were compared between the two groups. Results: The total effective rate in the observation group was higher than that in the control group, and the difference was statistically significant(P<0.05). After 2 weeks of treatment, the intracranial pressure in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). After 2 weeks of treatment, the white blood cell count and protein content of cerebrospinal fluid in the observation group were lower than those in the control group, while the glucose content was higher than that in the control group, with statistically significant differences(P<0.05). Conclusion: Intrathecal injection of vancomycin combined with continuous drainage of lumbar cistern is effective in the treatment of intracranial infection after STBI, and can reduce intracranial pressure and improve cerebrospinal fluid indexes, which is worthy of popularization and application.