鞘内注射万古霉素治疗重型颅脑外伤开颅术后MRSA颅内感染的临床研究

目的探讨鞘内注射万古霉素治疗重型颅脑外伤开颅术后耐甲氧西林金黄色葡萄球菌（MRSA）颅内感染的临床效果及并发症。 方法回顾性分析济宁市第一人民医院重症医学科自2016年7月至2019年5月收治的27例重型颅脑外伤开颅术后MRSA颅内感染患者的病例资料，评价鞘内注射万古霉素的临床效果，并统计并发症。 结果大多数患者的临床表现较治疗前均有显著改善，其中痊愈11例，显效8例，进步6例，无效2例（1例因多脏器功能衰竭，1例因重症肺炎并急性呼吸窘迫综合征）。临床总有效率为92.59%，病死率为7.41%，细菌清除率为100%。所有患者治疗期间均未出现明显并发症。 结论腰大池通畅引流联合鞘内注射万古霉素能有效控制MRSA颅内感染，且无明显并发症。

Clinical study of intrathecal injection of vancomycin in the treatment of intracranial infection with methicillin-resistant Staphylococcus aureus after craniotomy for severe craniocerebral trauma

ObjectiveTo evaluate clinical effect and complications of intrathecal injection of vancomycin in the treatment of intracranial infection with methicillin-resistant staphylococcus aureus (MRSA) after craniotomy for severe craniocerebral trauma. MethodsTwenty-seven patients with MRSA intracanial infection were analyzed retrospectively from July 2016 to May 2019. Clinical effect and complications of intrathecal injection of vancomycin in the treatment of intracranial infection with MRSA after craniotomy for severe craniocerebral trauma were evaluated. ResultsThe clinical manifestations of most patients were significantly improved compared with those before treatment, including 11 cases of recovery, 8 cases of significant effect, 6 cases of progress, and 2 cases of no effect (1 case due to multiple organ failure, 1 case due to severe pneumonia complicated with acute respiratory distress syndrome). The total clinical effective rate was 92.59%, the mortality rate was 7.41%, and the bacterial clearance rate was 100%. No obvious complications occurred in all patients during the treatment. ConclusionLumbar cistern drainage combined with intrathecal injection of vancomycin can effectively control the intracranial infection with MRSA, and no serious complications.