万古霉素鞘内梯度用药并持续腰骶引流治疗术后颅内葡萄球菌感染的疗效

目的探讨应用万古霉素鞘内梯度注射并腰骶引流对术后颅内葡萄球菌感染的治疗作用。方法对32例术后颅内葡萄球菌感染患者,腰骶穿刺后鞘内注入生理盐水20ml＋万古霉素并持续腰骶引流（continued lumbosacral cerebrospinal fluid drainage,CLCFD）,1次/d,剂量从20、40、60、80、100、120、140mg,逐日递增,共7d。在治疗前、后监测患者体温、血白细胞、颅内压（intracranial pressure,ICP）、脑脊液常规、生化指标及细菌培养。结果用万古霉素鞘内注射治疗前各指标高于正常值,注射后1d各指标较用药前略升高（P〉0.5）,治疗2～3d后逐渐下降,4～7d即出现颅内压降低,体温、白细胞计数、脑脊液生化及常规指标恢复正常;治疗前、后对比各指标差异明显（P〈0.05,P〈0.01）,无并发症发生。结论应用万古霉素鞘内梯度注射并持续腰骶引流治疗颅内葡萄球菌感染疗效显著,操作简便,无毒副作用,是临床治疗颅内葡萄球菌感染可行的方法。

Therapeutic Efficacy of Combined Vancomycin Infusion and Continuous Lumbosacral Cerebrospinal Fluid Drainage in the Treatment of Staphylococci-Induced Intracranial Infection after Craniotomy

Objective To evaluate the efficacy of combined intracranial injecton of Vancomycin and continuous lumboscral cerebrospinal fluid drainage on staphylococci-induced intracranial infection after the craniotomy. Methods Thirty-two patients with intracranial staphylococci infection after eraniotomy were treated with intrathecal injection with Vancomycin in 20 ml normal saline and continuous lumboscral cerebrospinal fluid drainage. The dosage of Vancomycin was stepwisely increased daily from 20 mg, 40 mg, 60 mg, 80 mg, 100 mg, 120 mg to 140 mg for 7 days after the operation. Bacterial culture, routine and biochemical examinations of eerebrospinal fluid, body temperature, white blood cell count and intracranial pressure were monitored before and after the antibiotic treatment. Results All the observed indexes were abnormal before intrathecal injection. One day after the treatment, the indexes were slightly increased （P〉0.5） and the values were then gradually improved 2 to 3 days after the intrathecal injection. The body temperature, intraeanial pressure and eerebrospinal fluid became normal at day-4 to 7 after the treatment, and the results were significantly different （P〈0.05）. No complication was found in these patients. Conclusion The present protocol of intraeranial injection of Vancomyein and continuous drainage of lumboscral eerebrospinal fluid is an effective and practical method to treat patients with staphylococci-induced intracranial infection after the eraniotomy.