经不同途径应用万古霉素治疗兔细菌性脑室炎的效果

目的 探讨经不同途径应用万古霉素治疗兔细菌性脑室炎的效果。方法 将新鲜配制的标准表皮葡萄球菌混悬液0.5 ml以0.1 ml/min的速度缓慢注入侧脑室将制作兔细菌性脑室炎模型。将50只细菌性脑室炎成年新西兰大白兔随机分为单纯静脉组（Ⅰ组，静脉注射万古霉素）、单纯动脉组（Ⅱ组，颈内动脉注射万古霉素）、联合静脉组（Ⅲ组，先静脉注射甘露醇，继而注射万古霉素）、联合动脉组（Ⅳ组，先颈内动脉注射甘露醇，继而注射万古霉素），对照组（Ⅴ组，静脉注射生理盐水），每组10只。所有动物均12 h给药一次，直至动物死亡，最多给药6次。结果 Ⅰ组、Ⅱ组给药后96 h内无动物死亡，Ⅲ组给药后72~96 h死亡5只，Ⅳ组给药后72~96 h死亡1只，Ⅴ组给药后24 h内全部死亡。首次给药后1 h，Ⅰ、Ⅱ、Ⅲ、Ⅳ组脑脊液万古霉素浓度分别为（40.02±0.07）μg/L、（89.11±0.19）μg/L、（69.02±0.17）μg/L、（118.13±0.31）μg/L；两两比较，均有统计学差异（P<0.05）。给药72 、96 h，Ⅳ组肛温、外周血白细胞数、脑脊液白细胞数均明显低于Ⅲ组（P<0.05）。结论 经颈内动脉联合应用甘露醇和万古霉素治疗细菌性脑室炎的效果优于单纯静脉或动脉注射万古霉素以及经静脉联合应用甘露醇和万古霉素的效果。

Effect of vancomycin administered via different ways on bacterial ventriculitis in adult rabbits

Objective To investigate the effect of vancomycin administered via different ways on bacterial ventriculitis in adult rabbits. Methods Fifty adult rabbits with bacterial ventriculitis established by injection of Staphylococcus epidermidis suspension into the cella lateralis of rabbits were randomly divided into 5 groups of 10 animals each, i.e. group Ⅰ in which the animals received intravenous injection of vacomycin, group Ⅱ in which the animals received intraarterial injection of vacomyin, group Ⅲ in which the animals received intravenous injection of vacomycin after the intravenous infusion of mannitol, group Ⅳ in which the animals received intraarterial injection of vacomycin after the intraarterial infusion of mannitol and group V in which the animals received intravenous injection of physiological saline. The treatment (once every 12 hours and total 6 times) began after blood and cerebrospinal fluid (CSF) samples were taken. The rectal temperature and rate of animal survival were observed in all the groups. The concentration of vancomycin in CSF was measured, and routine examinations of blood and CSF were performed in all the animals. Results The CSF concentration of vancomycin in group Ⅳ is the highest among these 5 groups after the first administration of vacomycin (P<0.05). The rate of animal survival was 90% (9/10) in group Ⅳ, it was 50%(5/10) in the group Ⅲ and all the animals dead in group Ⅰ, Ⅱ and Ⅴ 96 hours after the treatment. The rectal temperature and numbers of blood and CSF leukocytes were significantly lower in group Ⅳ than those in group Ⅲ 96 hours after the treatment (P<0.05). Conclusion It is suggested that the intraarterial injection of vacomycin after the intraarterial injection of mannitol may enhance the curative effects of the vacomycin on the bacterial ventriculitis compared to simple intraarterial injection or intravenous injection of the vacomycin after the intravenous injection of mannitol.