鞘内注射万古霉素并地塞米松治疗小儿难治性化脓性脑膜炎的疗效研究

目的 观察并探讨静脉注射美罗培南基础上联合鞘内注射万古霉素并地塞米松治疗小儿难治性化脓性脑膜炎的疗效与安全性.方法 将2014年6月至2015年3月青海省妇女儿童医院收治的90例难治性化脓性脑膜炎患儿依据随机数字表分为观察组(45例)和对照组(45例),对照组静脉注射美罗培南,观察组在对照组基础上加用鞘内注射万古霉素并地塞米松,治疗7d后比较两组血清炎性标志物变化及临床疗效,随访3个月,记录后遗症发生率.结果 治疗7d后,观察组肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)水平下降幅度(87.3±21.8)pg/mL、(47.9±10.7) mg/L、(348.9±67:3)pg/mL]均明显高于对照组(61.5±18.5) pg/mL、(33.0士7.9)mg/L、(263.7±61.5) pg/mL],差异有统计学意义(P＜0.05).两组临床疗效比较,差异有统计学意义(Z=2.086,P=0.037),观察组总有效率(93.3％)高于对照组(82.2％)(x2=2.589,P=0.108).观察组平均治疗时间(12.8±3.9)d]明显少于对照组(16.7±4.7)d],差异有统计学意义(t=4.216,P＜0.01).两组药物不良反应及后遗症发生率比较,差异无统计学意义(P＞0.05).结论 小儿难治性化脓性脑膜炎在静脉注射美罗培南基础上联合鞘内注射万古霉素并地塞米松能进一步抑制炎性反应,提高临床疗效,并且未显著增加药物不良反应.

Efficacy of intrathecal injection of vancomycin and dexamethasone in treating refractory purulent meningitis in children

Objective To observe and investigate the efficacy and safety of combining with intrathecal injection of vancomycin and dexamethasone based on intravenous meropenem for treating refractory purulent meningitis in children.Methods Ninety children cases of refractory purulent meningitis from June 2014 to March 2015 were randomized into the observation group (45 cases) and control group (45 cases) according to the random number table method.The control group was given intravenous meropenem therapy,on this basis the observation group was added with intrathecal injection of vancomycin and dexamethasone.The changes of serum inflammatory markers and clinical efficacies after 7 d treatment were compared between the two groups,and the incidence rate of sequelae in the two groups were recorded after 3-months follow up.Results The descend ranges of TNF-a,CRP and PCT after 7 d treatment in the observation group were (87.3±21.8)pg/mL,(47.9±10.7)mg/L and (348.9J67.3)pg/mL,which were significantly higher than (61.5±18.5)pg/mL,(33.0± 7.9)mg/L,(263.7 ± 61.5)pg/mL in the control group(P＜0.05).There was statistically significant difference in clinical efficacy between the two groups (Z=2.086,P=0.037),the total effective rate in the observation group was 93.3 ％,which was higher than 82.2 ％ in the control group (x2 =2.589,P =0.108);the average treatment duration in the observation group was(12.8 ± 3.9)d,which was significantly less than (16.7 ± 4.7)d in the control group,the difference was statistically significant(t=4.216,P＜0.01).There were no statistically significant differences in the incidence rate of adverse drug reactions and sequelae between the two groups (P＞0.05).Conclusion With intrathecal injection of vancomycin and dexamethasone based on intravenous meropenem therapy for treating purulent meningitis,can further inhibit the inflammatory reaction,and increases clinical efficacy without significantly increasing adverse drug reactions.