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目的探讨儿童颅底骨折合并颅内感染万古霉素鞘内注射联合静脉用药的优越性。方法回顾性分析53例颅底骨折合并颅内感染患儿的临床资料。其中,32例采用鞘内注射联合静脉内用药,21例采用单纯静脉用药治疗。监测两种治疗方法3d后不同时间点脑脊液内的药物浓度,同时比较两组治疗后第1、3、5天体温、脑脊液细胞数的平均值。结果联合用药组脑脊液中万古霉素血药浓度高于单纯用药组(P<0.01),且稳定超过了耐甲氧西林金黄色葡萄球菌的MIC90(0.5~3.1mg/L)和表皮葡萄球菌的MIC90(3.1~4.0mg/L);两组患儿在治疗后体温均呈下降趋势,其中联合用药组体温均值在第3天已达正常,脑脊液细胞数也接近正常,与单纯用药组比较差异有统计学意义(P<0.05)。结论万古霉素鞘内注射联合静脉用药更容易到达最低抑菌浓度,明显缩短疗程,是治疗颅底骨折后颅内感染患儿的有效措施。
Objective To investigate the superiority of intrathecal injection of vancomycin in combination with intravenous injection for skull base fracture in children. Methods The clinical data of 53 children with skull base fracture and intracranial infection were retrospectively analyzed. Among them, 32 cases were treated with intrathecal injection and intravenous injection, and 21 cases were treated with intravenous drug alone. The concentration of drug in cerebrospinal fluid of the two treatment methods at different time points was monitored. The mean values of body temperature and cerebrospinal fluid cells were also compared on the 1st, 3rd and 5th day after treatment. Results The plasma concentration of vancomycin in cerebrospinal fluid of the combination group was higher than that of the pure drug group (P <0.01), and it was more stable than that of MIC90 (0.5-3.1 mg / L) of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis MIC90 (3.1 ~ 4.0mg / L). After treatment, the body temperature of both groups showed a decreasing trend. The mean body temperature of the combination group reached normal on the 3rd day and the number of CSF was close to normal, There was statistical significance (P <0.05). Conclusion Vancomycin intrathecal injection combined with intravenous drug more easily reach the minimum inhibitory concentration, significantly shorten the course of treatment is effective in children with intracranial infection after skull base fracture treatment.