美罗培南联合头部亚低温治疗对化脓性脑膜炎患儿预后及血清和脑脊液中降钙素原、降钙素基因相关肽和C-反应蛋白水平的影响
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摘要
目的探讨美罗培南联合头部亚低温治疗对化脓性脑膜炎患儿预后及血清和脑脊液中降钙素原(PCT)、降钙素基因相关肽(CGRP)、C-反应蛋白(CRP)水平的影响。方法选择2015年1月至2017年4月南阳市第二人民医院收治的94例化脓性脑膜炎患儿为研究对象,根据治疗方法将患儿分为观察组和对照组,每组47例。2组患儿均给予维持水电解质酸碱平衡、退热、镇静、免疫增强、降颅压等对症支持治疗;在此基础上,对照组患儿给予美罗培南治疗,观察组患儿给予美罗培南联合头部亚低温治疗。治疗结束后,采用Glasgow结局量表评分对2组患儿的预后进行评估;于治疗前及治疗后采集2组患儿外周静脉血和脑脊液,分别采用免疫荧光法、放射免疫分析法、速率散射比浊法检测血清和脑脊液中PCT、CGRP、CRP水平。结果观察组和对照组患儿预后良好率分别为95. 74%(45/47)、80. 85%(38/47),观察组患儿预后良好率高于对照组(χ~2=4. 375,P <0. 05)。2组患儿治疗前血清及脑脊液中PCT、CGRP、CRP水平比较差异无统计学意义(P> 0. 05); 2组患儿治疗后血清及脑脊液中PCT、CGRP、CRP水平显著低于治疗前(P <0. 05);治疗后,观察组患儿血清及脑脊液中PCT、CGRP、CRP水平显著低于对照组(P <0. 05)。结论美罗培南联合亚低温治疗可显著降低化脓性脑膜炎患儿血清及脑脊液中CGRP、PCT、CRP水平,减轻炎症反应,增强感染控制效果,改善患儿预后。
Objective To investigate the effect of meropenem combined with local mild hypothermia therapy on the prognosis and the levels of procalcitonin( PCT),calcitonin gene-related peptide( CGRP) and C-reactive protein( CRP) in serum and cerebrospinal fluid in children with purulent meningitis. Methods A total of 94 children with suppurative meningitis in the Second People's Hospital of Nanyang City from January 2015 to April 2017 were selected as the subjects. The children were divided into observation group and control group according to the treatment method,47 cases in each group. All children were given symptomatic supportive treatment such as maintenance of acid-base balance and electrolyte balance,antipyretic,sedation,immune enhancement and reducing the intracranial pressure. On the basis of routine treatment,the children in the control group were treated with meropenem,while the children in the observation group were treated with meropenem combined with local mild hypothermia. The prognosis of the children in the two groups was evaluated by Glasgow outcome scale after treatment. The peripheral venous blood and cerebrospinal fluid were collected before and after treatment.The level of PCT in serum and cerebrospinal fluid was detected by immunofluorescence,the level of CGRP in serum and cerebrospinal fluid was detected by radioimmunoassay,and the level of CRP in serum and cerebrospinal fluid was detected by velocity scattering turbidimetry. Results The eusemia rate in the observation group and control group was 95. 74%( 45/47)and 80. 85%( 38/47),respectively. The eusemia rate in the observation group was higher than that in the control group( χ~2=4. 375,P < 0. 05). There was no significant difference in the levels of PCT,CGRP and CRP in serum and cerebrospinal fluid between the two groups before treatment( P > 0. 05). The levels of PCT,CGRP and CRP in serum and cerebrospinal fluid after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of PCT,CGRP and CRP in serum and cerebrospinal fluid in the observation group were significantly lower than those in the control group after treatment( P < 0. 05). Conclusion Meropenem combined with local mild hypothermia therapy can significantly reduce the levels of CGRP,PCT and CRP in serum and cerebrospinal fluid,alleviate inflammation,enhance the effect of infection control and improve the prognosis of children with purulent meningitis.
Objective To investigate the effect of meropenem combined with local mild hypothermia therapy on the prognosis and the levels of procalcitonin( PCT),calcitonin gene-related peptide( CGRP) and C-reactive protein( CRP) in serum and cerebrospinal fluid in children with purulent meningitis. Methods A total of 94 children with suppurative meningitis in the Second People's Hospital of Nanyang City from January 2015 to April 2017 were selected as the subjects. The children were divided into observation group and control group according to the treatment method,47 cases in each group. All children were given symptomatic supportive treatment such as maintenance of acid-base balance and electrolyte balance,antipyretic,sedation,immune enhancement and reducing the intracranial pressure. On the basis of routine treatment,the children in the control group were treated with meropenem,while the children in the observation group were treated with meropenem combined with local mild hypothermia. The prognosis of the children in the two groups was evaluated by Glasgow outcome scale after treatment. The peripheral venous blood and cerebrospinal fluid were collected before and after treatment.The level of PCT in serum and cerebrospinal fluid was detected by immunofluorescence,the level of CGRP in serum and cerebrospinal fluid was detected by radioimmunoassay,and the level of CRP in serum and cerebrospinal fluid was detected by velocity scattering turbidimetry. Results The eusemia rate in the observation group and control group was 95. 74%( 45/47)and 80. 85%( 38/47),respectively. The eusemia rate in the observation group was higher than that in the control group( χ~2=4. 375,P < 0. 05). There was no significant difference in the levels of PCT,CGRP and CRP in serum and cerebrospinal fluid between the two groups before treatment( P > 0. 05). The levels of PCT,CGRP and CRP in serum and cerebrospinal fluid after treatment were significantly lower than those before treatment in the two groups( P < 0. 05). The levels of PCT,CGRP and CRP in serum and cerebrospinal fluid in the observation group were significantly lower than those in the control group after treatment( P < 0. 05). Conclusion Meropenem combined with local mild hypothermia therapy can significantly reduce the levels of CGRP,PCT and CRP in serum and cerebrospinal fluid,alleviate inflammation,enhance the effect of infection control and improve the prognosis of children with purulent meningitis.
引文
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[15]胡雪姣,李映良,梁平,等.婴幼儿细菌性脑膜炎后脑积水的治疗[J].中华实用儿科临床杂志,2017,32(6):478-480.
[16]李静,李占魁,黄绍平.化脓性脑膜炎和病毒性脑膜炎患儿脑脊液中TNF-α和CGRP水平测定与临床意义[J].陕西医学杂志,2003,32(4):340-341.
[17]李振光,刘刚.化脓性脑膜炎患儿血液及脑脊液中CD64、PCT水平变化[J].山东医药,2014,54(7):76-77.
[18]李福照.降钙素原临床应用研究进展[J].新乡医学院学报,2017,34(8):776-778.
[19]王文徽,韩虹,武运红,等. C反应蛋白、白细胞计数及血脑脊液降钙素原在化脓性脑膜炎中的诊断价值[J].中国药物与临床,2015,15(10):1410-1412.
[2]河北省新生儿脑膜炎研究协作组.河北省新生儿化脓性脑膜炎多中心流行病学研究[J].中国当代儿科杂志,2015,17(15):419-424.
[3]吴丽文,韩蔚,王国丽,等.中西部地区儿童细菌性脑膜炎的病原学及诊断分析[J].中华实用儿科临床杂志,2018,33(10):778-782.
[4]毛劲,栗燕,石芸.地塞米松联合美罗培南治疗小儿化脓性脑膜炎的临床研究[J].现代药物与临床,2017,32(8):1491-1494.
[5]蒙钟文,杨恒,黄维国.亚低温辅助治疗颅内感染合并高热的临床研究[J].中华医院感染学杂志,2014,24(15):3739-3741.
[6]胡亚美,江载芳.诸福棠实用儿科学[M]. 7版.北京:人民卫生出版社,2002:912-916.
[7]洪舒婷.儿童化脓性脑膜炎临床及近期不良预后的危险因素分析[D].福州:福建医科大学,2014.
[8]刘钢,张二清,陈荷英,等.儿童化脓性脑膜炎不良预后危险因素探讨[J].临床儿科杂志,2011,29(2):148-152.
[9]高洁,杨丽,毛雪,等.新生儿化脓性脑膜炎临床分析[J].中华妇幼临床医学杂志:电子版,2014,10(1):9-12. DOI:10. 3877/cma. j. issn. 1673-5250. 2014. 01. 003.
[10]胡伟,王秉圆,李继安,等.儿童化脓性脑膜炎病原菌分布及其耐药性分析[J].临床儿科杂志,2017,35(5):366-368.
[11]张丽娜,吴铁军,田锁臣,等.血管内热交换技术成功救治重度化脓性脑膜炎伴持续高热1例[J].中国中西医结合急救杂志,2014,21(4):319-320.
[12]张赛.亚低温对急性神经损伤保护作用的争议与展望[J].中华神经外科杂志,2013,29(2):112-115.
[13]王学义,马承君,王莹莹,等.亚低温方案的临床应用[J].中华急诊医学杂志,2012,21(7):741-745.
[14]冯金周,曾俊,江华,等.亚低温对重型颅脑损伤患者静息能力消耗影响的随机对照研究[J].中华神经外科杂志,2015,31(2):192-195.
[15]胡雪姣,李映良,梁平,等.婴幼儿细菌性脑膜炎后脑积水的治疗[J].中华实用儿科临床杂志,2017,32(6):478-480.
[16]李静,李占魁,黄绍平.化脓性脑膜炎和病毒性脑膜炎患儿脑脊液中TNF-α和CGRP水平测定与临床意义[J].陕西医学杂志,2003,32(4):340-341.
[17]李振光,刘刚.化脓性脑膜炎患儿血液及脑脊液中CD64、PCT水平变化[J].山东医药,2014,54(7):76-77.
[18]李福照.降钙素原临床应用研究进展[J].新乡医学院学报,2017,34(8):776-778.
[19]王文徽,韩虹,武运红,等. C反应蛋白、白细胞计数及血脑脊液降钙素原在化脓性脑膜炎中的诊断价值[J].中国药物与临床,2015,15(10):1410-1412.