摘要
目的探讨鞘内注射治疗开颅术后颅内感染的临床疗效,为临床选择安全、有效的治疗药物和给药方式提供参考依据。方法将60例颅底骨折合并脑脊液漏开颅术后颅内感染患者随机分为观察组和对照组,每组各30例,对照组患者术后给予万古霉素静脉滴注治疗,观察组患者术后给予鞘内注射万古霉素治疗,治疗结束后第1、3、5天测定脑脊液生化指标,治疗结束后第5天评价临床疗效。结果观察组总有效率为93.3%,对照组为63.3%,两组总体疗效经χ2检验差异有统计学意义(χ2=7.954,P<0.05);观察组治疗后1、3、5d的白细胞计数水平分别为(117.72±39.24)、(89.12±28.29)、(69.06±24.23)×106/L,蛋白水平分别为(0.34±0.11)、(0.21±0.07)、(0.12±0.04)g/L,随着治疗时间的延长,观察组白细胞计数和蛋白水平程下降趋势,对照组程上升趋势,与前一次治疗后的水平比较差异均有统计学意义(P<0.05)。结论鞘内注射万古霉素是一种安全、有效、简单的治疗颅底骨折合并脑脊液漏行开颅术后颅内感染的方法,值得临床推广应用。
OBJECTIVE To explore the clinical efficacy of lumbar puncture combined with intrathecal injection in treatment of intracranial infections after craniotomy so as to provide reference for choosing the safe and effective antibiotics as well as the appropriate administration. METHODS A total of 60 cases of skull base fracture patients complicated with cerebrospinal fluid leakage, who were complicated with intracranial infections after craniotomy, were enrolled in the study and randomly divided into the observation group and the control group, with 30 cases in each. The patients of the control group were treated by using vancomycin infusion therapy, and the observation group was treated by using lumbar puncture combined with intrathecal vancomycin injection therapy, then the CSF biochemical markers were detected respectively on 1 day,3 days, or 5 days after the treatment, and the clinical efficacy was evaluated 5 days after treatment. RESULTS The total effective rate was 93.3% in the observation group, 63. 3% in the control group , the cbi-square test showed that the difference in the total effective rate between the two groups was statistically significant （22 ±7. 954, P〈0. 05）. the WBC counts on the 1 day, three days,or five days after the treatment were （117. 72±39.24）×10^6/L, （89.12±28.29）×10^6/L, and （69.06±24. 23）×10^6/L, respectively in the observation group, and the protein levels on the 1 day, three days ,or five days after the treatment were （0. 34±0. 11）, （0. 21±0. 07）, and （0. 12±0. 04） g/L, respectively in the observation group, as the duration of treatment prolonged, the WBC count and the protein level showed a downward tend, while an upward trend in the control group, as compared with the level after prior treatment,the difference was statistically significant （P〈0. 05）. CONCLUSION Lumbar puncture combined with intrathecal vancomycin injection therapy is a safe, effective ,and simple method for the treatment of intracranial infections in the skull base fracture patients complicated with cerebrospinal fluid leakage after the craniotomy , and kt is worthy of clinical application.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第22期5448-5450,共3页
Chinese Journal of Nosocomiology
基金
河南省教育厅基金项目(2009A310003)
关键词
鞘内注射
万古霉素
开颅手术
颅内感染
颅底骨折
脑脊液漏
Intrathecal injection
Vancomycin
Craniotomy
Intracranial infection
Fracture of skull base
Cerebrospinal fluid leakage
