鞘内阶梯浓度用药治疗术后颅内葡萄球菌感染的临床研究

目的探讨单纯应用万古霉素鞘内阶梯浓度注射对术后颅内葡萄球菌感染的治疗作用。方法31例颅内葡萄球菌感染患者腰穿后鞘内注入生理盐水20ml＋盐酸万古霉素，1次，d，剂量从20mg、40mg、60mg、80mg、100mg、120mg、140mg逐日递增，共7d。在治疗前、后监测患者体温、颅内压、脑脊液常规、生化指标及细菌培养。结果万古霉素鞘内注射治疗前各项指标明显异常，治疗2～3d后逐渐改善，5～7d即出现颅内压降低，体温、脑脊液生化及常规指标趋于正常；治疗前与治疗后3～7d各项指标差异明显（P＜0．05），无并发症发生。结论单纯应用万古霉素鞘内阶梯浓度注射治疗术后颅内葡萄球菌感染疗效显著，操作简便，无毒副作用．是临床治疗颅内感染可行的方法。

Clinical Study of Treating Staphylococci-induced Intracranial Infection by Intrathecal Injection of Vancomycin According to Concentration Gradient

Objective To observe the curative effect of intrathecal injection of vancomycin on staphylococci- induced intracranial infection after the craniotomy. Methods Thirty-one patients with intracranial infection induced by staphylococci after the craniotomy were treated by intrathecal injection of normal saline 20 ml plus vancomycin. The vancomycin dose per day was 20 mg, 40 mg, 60 rag, 80 mg, 100 mg, 120 mg and 140 mg respectively 1, 2, 3, 4, 5, 6 and 7 days after the operation. The bacterial culture, routine and biochemical examinations of cerebrospinal fluid, and monitoring body temperature and intracranial pressure were performed before and after the antibiotic treatment. Results All the observed indexes were abnormal before the intrathecal injection and were gradually improved 2 or 3 days after the intrathecal injection. The body temperature, intracranial pressure and cerebrospinal fluid trended to the normality from 5 to 7 days after the intrathecal injection. There were significant differences in all the observed indexes between pretreatment and posttreatment （P〈0.05）. No complications occurred in all the patients. Conclusion The intrathecal injection of vancomycin according to concentration gradient is an effective and practicable method to treat staphylococci -induced intracranial infection after the craniotomy.