静脉注射美罗培南联合鞘内注射万古霉素与地塞米松治疗小儿难治性化脓性脑膜炎的疗效与安全性
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摘要
目的探讨静脉注射美罗培南基础上联合鞘内注射万古霉素与地塞米松治疗小儿难治性化脓性脑膜炎的疗效与安全性。方法将2016年1月至2018年1月本院收治的72例难治性化脓性脑膜炎患儿随机分为两组:观察组36例给予美罗培南静脉注射联合万古霉素、地塞米松鞘内注射,对照组36例仅给予美罗培南静脉注射,用药1w后,比较两组临床疗效、体温恢复正常时间、脑膜刺激征消失时间、用药时间、两组治疗前后血清降钙素原(PCT)、神经元特异性烯醇化酶(NSE)、C反应蛋白(CRP)和肿瘤坏死因子(TNF-α)水平,并记录两组患儿不良反应和后遗症发生情况。结果观察组治疗显效率为58.33%,显著高于对照组的41.67%(P<0.05),但两组治疗总有效率比较(P>0.05);与对照组比较,观察组体温恢复正常时间、脑膜刺激征消失时间、用药时间均显著缩短(P<0.05);两组治疗后的血清PCT、NSE、CRP和TNF-α水平均显著低于治疗前(P<0.05),且观察组低于对照组(P<0.05);两组不良反应主要表现为腹泻、癫痫、肝转氨酶升高,后遗症包括偏瘫和语言功能障碍,但发生率相当(P>0.05);观察组死亡率为2.78%,与对照组的5.56%相当(P>0.05)。结论对于儿童难治性化脓性脑膜炎,在静脉注射美罗培南基础上给予万古霉素、地塞米松鞘内注射治疗起效快速、疗效确切,可显著下调血清炎性因子水平,且不增加药物不良反应,用药安全。
Objective To investigate the efficacy and safety of intravenous meropenem combined with intrathecal vancomycin and dexamethasone in the treatment of children with purulent meningitis. Method 72 children with refractory purulent meningitis admitted to our hospital from January 2016 to January 2018 were randomly divided into two groups:in observation group, 36 patients were given meropenem intravenously combined with vancomycin and intrathecal injection of dexamethasone, in the control group, only meropenem was injected intravenously in 36 cases, after one week of treatment, the clinical efficacy, time to return to normal body temperature, disappearance time of meningeal irritation, duration of administration, serum PCT, NSE, CRP, and TNF-α levels were compared between the two groups before and after treatment. Adverse reactions and adverse reactions were recorded in both groups. The occurrence of sequelae. Results The effective rate of observation in the observation group was 58.33%, which was significantly higher than that in the control group(41.67%)(P<0.05). however, there was no significant difference in total effective rate between the two groups(P>0.05). Compared with the control group, the normal time for recovery of body temperature, disappearance of meningeal irritation sign, and medication time were all significantly shortened in the observation group(P<0.05). The serum PCT, NSE, CRP and TNF-α levels after treatment in both groups were significantly lower than before treatment(P<0.05), and the observation group was lower than the control group(P<0.05). The main adverse reactions in the two groups were diarrhea, epilepsy, elevated liver transaminases, sequelae including hemiplegia and language dysfunction, but there was no significant difference in the data(P>0.05). The mortality rate in the observation group was 2.78%, which was equivalent to 5.56% in the control group(P>0.05). Conclusion For children with refractory purulent meningitis, intrathecal injections of vancomycin and dexamethasone on the basis of intravenous meropenem have a rapid onset of action and a definite curative effect, which can significantly reduce serum inflammatory factors without increasing drug abuse. Response, medication safety.
Objective To investigate the efficacy and safety of intravenous meropenem combined with intrathecal vancomycin and dexamethasone in the treatment of children with purulent meningitis. Method 72 children with refractory purulent meningitis admitted to our hospital from January 2016 to January 2018 were randomly divided into two groups:in observation group, 36 patients were given meropenem intravenously combined with vancomycin and intrathecal injection of dexamethasone, in the control group, only meropenem was injected intravenously in 36 cases, after one week of treatment, the clinical efficacy, time to return to normal body temperature, disappearance time of meningeal irritation, duration of administration, serum PCT, NSE, CRP, and TNF-α levels were compared between the two groups before and after treatment. Adverse reactions and adverse reactions were recorded in both groups. The occurrence of sequelae. Results The effective rate of observation in the observation group was 58.33%, which was significantly higher than that in the control group(41.67%)(P<0.05). however, there was no significant difference in total effective rate between the two groups(P>0.05). Compared with the control group, the normal time for recovery of body temperature, disappearance of meningeal irritation sign, and medication time were all significantly shortened in the observation group(P<0.05). The serum PCT, NSE, CRP and TNF-α levels after treatment in both groups were significantly lower than before treatment(P<0.05), and the observation group was lower than the control group(P<0.05). The main adverse reactions in the two groups were diarrhea, epilepsy, elevated liver transaminases, sequelae including hemiplegia and language dysfunction, but there was no significant difference in the data(P>0.05). The mortality rate in the observation group was 2.78%, which was equivalent to 5.56% in the control group(P>0.05). Conclusion For children with refractory purulent meningitis, intrathecal injections of vancomycin and dexamethasone on the basis of intravenous meropenem have a rapid onset of action and a definite curative effect, which can significantly reduce serum inflammatory factors without increasing drug abuse. Response, medication safety.
引文
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[11]Tseng YC,Kan LP,Huang LY,et al.Successful treatment of a patient with ventriculoperitoneal shunt-associated meningitis caused by extended-spectrum beta-lactamase-producing klebsiella pneumoniae[J].Tohoku J Exp Med,2014,233(4):301-305.
[12]Kazi R,Kazi HA,Ruggeri C,et al.Eosinophilic meningitis secondary to intravenous vancomycin[J].J Pharm Pract,2013,26(3):261-263.
[13]Shokouhi S,Alavi Darazam I.Determination of vancomycin trough level in serum and cerebrospinal fluid of patients with acute community-acquired meningitis:A prospective study[J].JInfection,2014,69(5):424-429.
[14]Esposito S,Semino M,Picciolli I,et al.Should corticosteroids be used in bacterial meningitis in children?[J].Eur J Paediatr Neuro,2013,17(1):24-28.
[15]Koedel U,Klein M,Pfister HW.Modulation of brain injury as a target of adjunctive therapy in bacterial meningitis[J].Curr Infect Dis Rep,2010,12(4):266-273.
[16]Uppal L,Singhi S,Singhi P,et al.Role of rifampin in reducing inflammation and neuronal damage in childhood bacterial meningitis:a pilot randomized controlled trial[J].Pediatr Infect Dis J,2017,36(6):556-559.
[17]Macagno N,Figarella-Branger D,Mokthari K,et al.Differential diagnosis of meningeal SFT-HPC and meningioma:which immunohistochemical markers should be used?[J].Am J Surg Pathol,2016,40(2):270-278.
[18]Izadpanah K,Freyer D,Weber JR,et al.Brain parenchymal TNF-αand IL-1βinduction in experimental pneumococcal meningitis[J].Neuroimmunol,2014,276(1-2):104-111.
[19]Bukhari EE,Alotibi FE.Fatal streptococcus melleri meningitis complicating missed infected intramedullary dermoid cyst secondary to dermal sinus in a saudi child[J].J Trop Pediatrics,2013,59(3):246-249.
[2]van Rappard JR,Tolenaar JL,Smits AB,et al.Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia[J].BMJ Case Rep,2015,pii:bcr201510867.
[3]Malheiro L,Gomes A,Barbosa P,et al.Infectious complications of intrathecal drug administration systems for spasticity and chronic pain:145 patients from a tertiary care center[J].Neuromodulation,2015,18(5):421-427.
[4]胡亚美,江载芳.诸福棠实用儿科学[M].8版.北京:人民卫生出版社,2012:15-16.
[5]Lucas MJ,Brouwer MC,Bovenkerk S,et al.Group a streptococcal meningitis in adults[J].J Infect,2015,71(1):37-42.
[6]Kamoun F,Dowlut MB,Ameur SB,et al.Neonatal purulent meningitis in southern tunisia:epidemiology,bacteriology,risk factors and prognosis[J].Fetal Pediatr Pathol,2015,34(4):233-240.
[7]Bardak Ozem S,Turhan T,Sipahi OR,et al.Daptomycin versus vancomycin in treatment of methicillin-resistant staphylococcus aureus meningitis in an experimental rabbit model[J].Antimicro Agents Chemother,2013,57(3):1556-1558.
[8]Cottagnoud P,Cottagnoud M,Acosta F,et al.Efficacy of ceftaroline fosamil against penicillin-sensitive and-resistant streptococcus pneumoniae in an experimental rabbit meningitis model[J].Antimicro Agents Chemother,2013,13(10):4653-4655.
[9]Nichols KR,Knoderer CA,Jackson NG,et al.Success with extendedinfusion meropenem after recurrence of baclofen pump-related achromobacter xylosoxidans meningitis in an adolescent[J].JPharm Pract,2015,28(4):430-433.
[10]Fujimoto K,Kanazawa K,Takemoto K,et al.Therapeutic effect of meropenem on an experimental guinea pig model of meningitis with type bβ-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae[J].J Infect Chemother,2013,19(4):593-598.
[11]Tseng YC,Kan LP,Huang LY,et al.Successful treatment of a patient with ventriculoperitoneal shunt-associated meningitis caused by extended-spectrum beta-lactamase-producing klebsiella pneumoniae[J].Tohoku J Exp Med,2014,233(4):301-305.
[12]Kazi R,Kazi HA,Ruggeri C,et al.Eosinophilic meningitis secondary to intravenous vancomycin[J].J Pharm Pract,2013,26(3):261-263.
[13]Shokouhi S,Alavi Darazam I.Determination of vancomycin trough level in serum and cerebrospinal fluid of patients with acute community-acquired meningitis:A prospective study[J].JInfection,2014,69(5):424-429.
[14]Esposito S,Semino M,Picciolli I,et al.Should corticosteroids be used in bacterial meningitis in children?[J].Eur J Paediatr Neuro,2013,17(1):24-28.
[15]Koedel U,Klein M,Pfister HW.Modulation of brain injury as a target of adjunctive therapy in bacterial meningitis[J].Curr Infect Dis Rep,2010,12(4):266-273.
[16]Uppal L,Singhi S,Singhi P,et al.Role of rifampin in reducing inflammation and neuronal damage in childhood bacterial meningitis:a pilot randomized controlled trial[J].Pediatr Infect Dis J,2017,36(6):556-559.
[17]Macagno N,Figarella-Branger D,Mokthari K,et al.Differential diagnosis of meningeal SFT-HPC and meningioma:which immunohistochemical markers should be used?[J].Am J Surg Pathol,2016,40(2):270-278.
[18]Izadpanah K,Freyer D,Weber JR,et al.Brain parenchymal TNF-αand IL-1βinduction in experimental pneumococcal meningitis[J].Neuroimmunol,2014,276(1-2):104-111.
[19]Bukhari EE,Alotibi FE.Fatal streptococcus melleri meningitis complicating missed infected intramedullary dermoid cyst secondary to dermal sinus in a saudi child[J].J Trop Pediatrics,2013,59(3):246-249.