摘要
目的 探讨脑室内注射万古霉素治疗颅脑术后耐甲氧西林金黄色葡萄球菌(MRSA)导致的颅内感染的疗效和安全性。方法 回顾性分析2018年2月至2020年12月收治的54例颅脑术后MRSA导致的颅内感染患者的临床资料。26例(对照组)仅给予静脉滴注万古霉素(1 000 mg,q12 h),28例(观察组)在静脉滴注万古霉素基础上,经脑室外引流管注射万古霉素治疗(10 ml生理盐水+25 mg万古霉素,夹闭2 h,根据感染严重程度,每日1~2次)。结果 观察组治愈率(85.7%)明显高于对照组(38.5%;P<0.001)。治疗1~5 d,观察组脑脊液白细胞下降率明显高于对照组(P<0.05)。观察组感染控制时间及症状缓解时间较对照组明显缩短(P<0.05)。观察组未出现耳鸣、听力下降、眩晕、抽搐、肝损伤、肾损伤、腹泻、血液学毒性等不良反应。结论对于颅脑术后MRSA导致的颅内感染,在静脉滴注万古霉素治疗基础上,脑室内注射万古霉素治疗,疗效更加显著,而且安全、耐受。
Objective To investigate the efficacy and safety of intraventricular vancomycin administration in the treatment of methicillin-resistant Staphylococcus aureus(MRSA)-induced intracranial infection following craniotomy.Methods A retrospective analysis was conducted on 54 patients with MRSA-induced intracranial infection after craniotomy,admitted between February 2018 and December 2020.The control group(26 patients)received systemic intravenous vancomycin alone(1000 mg every 12 hours),while the observation group(28 patients)received additional intraventricular vancomycin via an external ventricular drain(10 ml of normal saline containing 25 mg vancomycin,followed by 2-hour clamping of the catheter,administered 1~2 times daily depending on infection severity).Results The cure rate in the observation group was significantly higher than that in the control group(85.7%vs.38.5%;P<0.001).Within 1~5 days of treatment,the reduction rate of cerebrospinal fluid white blood cell count in the observation group was significantly greater compared to the control group(P<0.05).The infection control time and symptom relief time were also significantly shorter in the observation group(P<0.05).No adverse reactions,such as tinnitus,hearing loss,vertigo,seizures,hepatotoxicity,nephrotoxicity,diarrhea,or hematologic toxicity,were observed in the observation group.Conclusion For MRSA-induced intracranial infection following craniotomy,intraventricular vancomycin administration combined with systemic intravenous therapy significantly enhances therapeutic efficacy and demonstrates favorable safety and tolerability.
作者
李庆岗
程岗
孙君昭
张剑宁
刘如恩
LI Qing-gang;CHENG Gang;SUN Jun-zhao;ZHANG Jian-ning;LIU Ru-en(Department of Neurosurgery,Peking University People's Hospital(Second Clinical Medical School),Beijing 100044,China;Department of Neurosurgery,Beijing Beiya Orthopaedic Hospital,Beijing 102445,China;Department of Neurosurgery,The First Medical Center of PLA General Hospital,Beijing 100039,China)
出处
《中国临床神经外科杂志》
2025年第3期139-143,共5页
Chinese Journal of Clinical Neurosurgery
基金
全军医学科技青年培育基金(17QNP014)。
关键词
颅内感染
耐甲氧西林金黄色葡萄球菌
万古霉素
脑室注射
疗效
安全性
Intracranial infection
Methicillin-resistant Staphylococcus aureus
Vancomycin
Intraventricular injection
Efficacy
Safety
