摘要
目的探究万古霉素注射治疗脑出血后颅内感染的疗效及对脑脊液蛋白质、炎症反应的影响。方法回顾性分析2019-02-05-2020-12-20河南科技大学第一附属医院神经外科收治的脑出血后颅感染患者102例,根据用药方案的不同将患者分为万古霉素组(n=51)和其他抗生素组(n=51),其他抗生素组采用常规抗生素以及广谱抗菌药物治疗,万古霉素组接受万古霉素鞘内注射联合腰大池引流治疗。比较2组治疗总有效率;采集患者治疗前后脑脊液标本,检测蛋白质水平、白细胞计数;白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)变化情况。结果万古霉素组治疗后,45例有效,6例无效,总有效率为88.24%。其他抗生素组治疗后37例有效,14例无效,总有效率为72.55%,万古霉素组治疗有效率高于其他抗生素组,差异有统计学意义,χ^(2)=3.981,P=0.046。万古霉素组脑脊液蛋白(0.31±0.04)g/dL、白细胞计数(7.14±1.13)×10^(6)L^(-1)、其他抗生素组脑脊液蛋白(0.52±0.05)g/dL、白细胞计数(10.23±1.25)×10^(6)L^(-1)相比治疗前降低,差异有统计学意义,t值分别为31.888、15.322、15.544和7.151,均P<0.001;万古霉素组IL-6(0.28±0.04)ng/L、TNF-α(1.21±0.31)ng/mL和其他抗生素组IL-6(0.47±0.06)ng/L、TNF-α(1.76±0.36)ng/mL,相比治疗前降低,差异有统计学意义,t值分别为27.111、33.129、21.660和11.773,均P<0.001;万古霉素组上述指标改善情况优于其他抗生素组,差异有统计学意义,F值分别为2.116、4.751、2.342和2.313,均P<0.001。结论万古霉素鞘内注射联合腰大池引流能够有效提升脑出血后颅内感染患者治疗有效率、降低脑脊液蛋白、有效缓解炎症,具有较高应用价值。
Objective To explore the curative effect of vancomycin injection on intracranial infection after cerebral hemorrhage and its influences on cerebrospinal fluid proteins and inflammation response.Methods A total of 102 patients with intracranial infection after cerebral hemorrhage admitted to The First Affiliated Hospital of Henan University of Science and Technology were retrospectively analyzed between February 5,2019 and December 20,2020.According to different medication regimens,patients were divided into vancomycin group(n=51,vancomycin injection combined with lumbar cistern drainage)and other antibiotics group(n=51,routine anti-infection treatment).The total response rate of treatment,and changes in levels of cerebrospinal fluid proteins,white blood cell count,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)before and after treatment between the two groups were compared.Results In the vancomycin group,45 cases were effective and 6 cases were ineffective;in the other antibiotic group,37 cases were effective and 14 cases were ineffective.The total response rate of treatment in vancomycin group was significantly higher than that in other antibiotics group(88.24%vs 72.55%)(χ^(2)=3.981;P=0.046).The cerebrospinal fluid protein of vancomycin group was(0.31±0.04)g/dL,the white blood cell count was(7.14±1.13)×10^(6)L^(-1),the cerebrospinal fluid protein of other antibiotic group was(0.52±0.05)g/dL,the white blood cell count was(10.23±1.25)×10^(6)L^(-1).All were lower than the levels before treatment,the differences were statistically significant,t=31.888,15.322,15.544,7.151;all P<0.001;The IL-6 level of vancomycin group was(0.28±0.04)ng/L,the TNF-αlevel of vancomycin group was(1.21±0.31)ng/mL,the IL-6 level of other antibiotic group was(0.47±0.06)ng/L,the TNF-αlevel of other antibiotic group was(1.76±0.36)ng/mL.All were lower than the levels before treatment,the differences were statistically significant,t=27.111,33.129,21.660,11.773;all P<0.001;The improvement of the above indexes in vancomycin group was better than those in other antibiotic groups,the differences were statistically significant(F=2.116,4.751,2.342,2.313;all P<0.001).Conclusion Vancomycin injection combined with lumbar cistern drainage can effectively improve response rate of treatment in patients with intracranial infection after cerebral hemorrhage,reduce CSF proteins and effectively alleviate inflammation response.
作者
吉璐珊
翟继开
翟思瑞
JI Lu-shan;ZHAI Ji-kai;ZHAI Si-rui(Department of Neurosurgery,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang,471000,China)
出处
《社区医学杂志》
CAS
2022年第9期491-494,504,共5页
Journal Of Community Medicine
关键词
万古霉素
脑出血后颅内感染
脑脊液蛋白
炎症反应
vancomycin
intracranial infection after cerebral hemorrhage
cerebrospinal fluid protein
inflammation response
作者简介
通信作者:吉璐珊,女,河南洛阳人,主要从事神经外科的临床研究工作。E-mail:qafv41@163.com
