万古霉素与美罗培南鞘内注射对高血压脑出血后颅内感染的疗效分析

The therapeutic efficacy of intrathecal injection of vancomycin and meropenem in intracranial infection after hypertensive cerebral hemorrhage

摘要:

目的 对比高血压脑出血后颅内感染患者行万古霉素、美罗培南鞘内注射的疗效。方法 选取 2016年2月—2019年2月于中国人民解放军陆军第71集团军医院诊疗的62例高血压脑出血术后颅内感染患 者。根据不同的治疗方式将患者分为万古霉素组和美罗培南组，比较两组患者脑脊液中蛋白质、白细胞、葡 萄糖及相关炎症指标、不良反应情况。结果 万古霉素组治疗前后脑脊液中蛋白质、白细胞及葡萄糖的差值 均高于美罗培南组（P <0.05）；万古霉素组治疗前后脑脊液中白细胞介素-6、肿瘤坏死因子-α、C反应蛋白 水平及血清降钙素原、神经元特异性烯醇化酶的差值均高于美罗培南组（P <0.05）；万古霉素组总有效率高 于美罗培南组 （P <0.05），两组总不良反应率比较，差异无统计学意义 （P >0.05）。结论 与美罗培南鞘内 注射治疗相比，万古霉素鞘内注射治疗可显著改善高血压脑出血后颅内感染患者脑脊液中蛋白质、葡萄糖、 白细胞含量，抗炎效果更理想，能够获得更高治疗有效率，且药物不良反应较少。

Abstract:

Objective To evaluate the therapeutic efficacy of intrathecal injection of vancomycin and meropenem in patients with intracranial infection after hypertensive cerebral hemorrhage. Methods A total of 62 patients with intracranial infection after hypertensive cerebral hemorrhage treated in our hospital from February 2016 to February 2019 were divided into two groups. On the basis of continuous lumbar cistern drainage, vancomycin group (n = 31) was given intrathecal injection of vancomycin, while meropenem group (n = 31) was treated with meropenem intrathecal injection. The changes of protein, white blood cell, glucose and related inflammatory indexes in cerebrospinal fluid and the occurrence of adverse reactions were observed. Results The differences of the levels of protein and glucose and white blood cell count before and after the treatment in vancomycin group were significantly higher than those in meropenem group (P < 0.05). The differences of the levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) in cerebrospinal fluid, procalcitonin (PCT) and neuron-specific enolase (NSE) in serum before and after the treatment in vancomycin group were significantly higher than those in meropenem group (P < 0.05). The overall effective rate of vancomycin group after treatment was higher than that of meropenem group (P < 0.05). However, there was no significant difference between vancomycin group and meropenem group in the incidence of adverse reactions (P > 0.05). Conclusion Compared with meropenem intrathecal injection, intrathecal injection of vancomycin in patients with intracranial infection after hypertensive cerebral hemorrhage can significantly alter the contents of protein and glucose and white blood cell count in cerebrospinal fluid, with a better anti-inflammatory effect, a higher effective rate, and less adverse reactions.