【摘要】：目的觀察并探討靜脈注射美羅培南基礎(chǔ)上聯(lián)合鞘內(nèi)注射萬古霉素并地塞米松治療小兒難治性化膿性腦膜炎的療效與安全性。方法將2014年6月至2015年3月青海省婦女兒童醫(yī)院收治的90例難治性化膿性腦膜炎患兒依據(jù)隨機數(shù)字表分為觀察組(45例)和對照組(45例),對照組靜脈注射美羅培南,觀察組在對照組基礎(chǔ)上加用鞘內(nèi)注射萬古霉素并地塞米松,治療7d后比較兩組血清炎性標(biāo)志物變化及臨床療效,隨訪3個月,記錄后遺癥發(fā)生率。結(jié)果治療7d后,觀察組腫瘤壞死因子α(TNF-α)、C反應(yīng)蛋白(CRP)、降鈣素原(PCT)水平下降幅度[(87.3±21.8)pg/mL、(47.9±10.7)mg/L、(348.9±67.3)pg/mL]均明顯高于對照組[(61.5±18.5)pg/mL、(33.0±7.9)mg/L、(263.7±61.5)pg/mL],差異有統(tǒng)計學(xué)意義(P0.05)。兩組臨床療效比較,差異有統(tǒng)計學(xué)意義(Z=2.086,P=0.037),觀察組總有效率(93.3%)高于對照組(82.2%)(χ~2=2.589,P=0.108)。觀察組平均治療時間[(12.8±3.9)d]明顯少于對照組[(16.7±4.7)d],差異有統(tǒng)計學(xué)意義(t=4.216,P0.01)。兩組藥物不良反應(yīng)及后遺癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論小兒難治性化膿性腦膜炎在靜脈注射美羅培南基礎(chǔ)上聯(lián)合鞘內(nèi)注射萬古霉素并地塞米松能進一步抑制炎性反應(yīng),提高臨床療效,并且未顯著增加藥物不良反應(yīng)。
[Abstract]:Objective to observe and evaluate the efficacy and safety of intravenous meropenem combined with intrathecal injection of vancomycin and dexamethasone in the treatment of refractory suppurative meningitis in children. Methods from June 2014 to March 2015, 90 children with refractory suppurative meningitis were randomly divided into observation group (n = 45) and control group (n = 45). Meropenem was injected intravenously into the control group. Vancomycin and dexamethasone were injected intrathecally in the observation group. The changes of serum inflammatory markers and clinical efficacy were compared between the two groups after 7 days of treatment. Record the incidence of sequelae. Results after 7 days of treatment, the level of tumor necrosis factor 偽 (TNF- 偽), C reactive protein (CRP), procalcitonin (PCT) in the observation group [(87.3 鹵21.8) pg/mL, (47.9 鹵10.7) mg/L, (348.9 鹵67.3) pg/mL] was significantly higher than that in the control group [(61.5 鹵18.5) pg/mL, (33.0 鹵7.9) mg/L, (263.7 鹵61.5) pg/mL]. The difference was statistically significant (P 0.05). There was significant difference between the two groups (Z 鈮，

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