万古霉素静脉滴注联用鞘内注射治疗颅内感染的Meta分析

目的 评价万古霉素静脉滴注联用鞘内注射治疗颅内感染的有效性和安全性。方法 检索2000年1月-2017年5月PubMed、中国知网（CNKI）、万方数据库、维普全文数据库（VIP）中的数据，收集万古霉素静脉滴注联用鞘内注射治疗颅内感染的临床随机对照研究（RCT），采用RevMan 5.2软件进行Meta分析。结果 共纳入9项RCTs，469例患者。Meta分析结果显示：相对于万古霉素静脉滴注，联用鞘内注射能显著提高临床治愈率RR=0.70，95%CI（0.61，0.81），P < 0.001]和耐甲氧西林金黄色葡萄球菌清除率RR=0.90，95%CI（0.81，1.00），P=0.04]，缩短治愈时间SMD=3.26，95%CI（2.84，3.68），P < 0.001]；两组不良反应发生率无统计学差异RR=0.73，95%CI（0.35，1.49），P=0.38]，但中枢神经根刺激症发生率较大RR=0.05，95%CI（0.00，0.92），P=0.04]。结论 万古霉素静脉滴注联用鞘内注射治疗颅内感染疗效确切，安全性好。

Meta-analysis of vancomycin injection combined with intrathecal injection in treatment of intracranial infection

Objective To evaluate the efficacy and safety of vancomycin intravenous infusion combined with intrathecal injection in treatment of intracranial infection. Methods Databases including PubMed, CNKI, VIP, and WanFang Data were searched to collect randomized controlled trials (RCTs) about vancomycin intravenous infusion combined with intrathecal injection in treatment of intracranial infection from January 2000 to May 2017. Meta-analysis was conducted by RevMan 5.2 software. Results Nine RCTs were collected, including 469 patients. The meta-analysis showed that, compared with intravenous infusion of vancomycin, intravenous infusion combined with intrathecal injection could significantly improve the clinical cure rateRR=0.70, 95%CI(0.61, 0.81), P < 0.001] and clearance rate of MRSARR=0.90, 95%CI(0.81, 1.00), P=0.04], shorten the cure timeSMD=3.26, 95%CI(2.84, 3.68), P < 0.001]. Also, there was no statistical difference in the incidence of adverse drug reactionsRR=0.73, 95%CI(0.35, 1.49), P=0.38], but the incidence of central nerve root irritation was higherRR=0.05, 95%CI(0.00, 0.92), P=0.04]. Conclusion Vancomycin intravenous injection combined with intrathecal injection is effective and safe in the treatment of intracranial infection.