美罗培南不同用药方式治疗脑胶质瘤术后颅内感染的效果分析

Efficacy of meropenem with different medication methods in treating intracranial infection after glioma surgery

  • 摘要:
    目的 观察鞘内注射联合静脉滴注美罗培南治疗脑胶质瘤术后颅内感染的效果。
    方法 将102例脑胶质瘤术后颅内感染患者随机分为对照组和观察组,每组51例。2组均给予静脉滴注头孢曲松和腰大池置管脑脊液外引流术治疗,在此基础上对照组采取静脉滴注美罗培南治疗,观察组采取鞘内注射联合静脉滴注美罗培南治疗。比较2组治疗效果,治疗后3 d症状缓解率及用药时间,治疗前后脑脊液炎性因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、感染指标γ-干扰素(IFN-γ)、T细胞免疫球蛋白黏蛋白分子-3(Tim-3)、可溶性细胞间黏附分子-1(sICAM-1)、脑脊液指标(白细胞计数、氯化物、葡萄糖)以及不良反应发生率。
    结果 观察组总有效率为92.16%,高于对照组的76.47%,差异有统计学意义(P<0.05)。治疗后3 d,观察组头痛缓解率、体温下降率、脑脊液糖定量正常率均高于对照组,用药时间短于对照组,差异有统计学意义(P<0.05)。治疗后,2组脑脊液IL-6、TNF-α、CRP水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,2组脑脊液IFN-γ、Tim-3、sICAM-1水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,2组白细胞计数低于治疗前,脑脊液氯化物、葡萄糖水平高于治疗前,且观察组白细胞计数低于对照组,脑脊液氯化物、葡萄糖水平高于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率为7.84%,对照组为11.76%,差异无统计学意义(P>0.05)。随访6个月时,观察组失访2例,对照组失访3例;观察组6个月总体生存率为91.84%(45/49),对照组为91.67%(44/48),差异无统计学意义(P>0.05)。
    结论 鞘内注射联合静脉滴注美罗培南能减少脑胶质瘤术后颅内感染患者治疗时间及药量,快速缓解症状,改善术后相关指标,降低炎性因子水平,促进恢复,安全性较高。

     

    Abstract:
    Objective To observe the efficacy of intrathecal injection combined with intravenous drip of meropenem in the treatment of patients with intracranial infection after glioma surgery.
    Methods A total of 102 patients with intracranial infection after glioma surgery were randomly divided into control group and observation group, with 51 cases in each group. Both groups were treated with intravenous drip of ceftriaxone and lumbar cistern catheterization for cerebrospinal fluid drainage. On this basis, the control group received intravenous drip of meropenem, while the observation group received intrathecal injection combined with intravenous drip of meropenem. Therapeutic effect, the symptom relief rate and medication time after 3 days of treatment, the inflammatory factors tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) in cerebrospinal fluid, infection indicatorsinterferon-γ (IFN-γ), T cell immunoglobulin mucin molecule-3 (Tim-3) and soluble intercellular adhesion molecule-1 (sICAM-1), cerebrospinal fluid indicators white blood cell count, chloride and glucose before and after treatment as well as incidence of adverse reactions were compared between two groups.
    Results The total effective rate of the observation group was 92.16%, which was significantly higher than 76.47% of the control group (P < 0.05). After 3 days of treatment, the relief rate of headache, decrease rate of body temperature and normal rate of cerebrospinal fluid glucose quantification in the observation group were significantly higher than those in the control group, while the medication time was significantly shorter than that in the control group (P < 0.05). After treatment, the IL-6, TNF-α and CRP levels in the cerebrospinal fluid were significantly lower than those before treatment in both groups, and the levels of indexes in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the IFN-γ, Tim-3 and sICAM-1 levels in the cerebrospinal fluid were significantly lower than those before treatment, and the levels of indexes in the observation group were significantly lower than those in the control group (P < 0.05). After treatment, the white blood cell count in both groups was significantly lower than that before treatment, while the levels of chloride and glucose in the cerebrospinal fluid were significantly higher than those before treatment, and the white blood cell count in the observation group was significantly lower than that in the control group, while the levels of chloride and glucose in the cerebrospinal fluid were significantly higher than those in the control group (P < 0.05). The incidence of adverse reactions was 7.84% in the observation group, which showed no significant difference when compared to 11.76% in the control group (P > 0.05). At the follow up of 6 months, 2 cases were lost in the observation group and 3 cases were lost in the control group; the overall 6-month survival rate of the observation group was 91.84% (45/49), which showed no significant difference when compared to 91.67% (44/48) in the control group (P > 0.05).
    Conclusion Intrathecal injection combined with intravenous drip of meropenem can reduce the treatment time and dosage of patients with intracranial infection after glioma surgery, quickly alleviate symptoms, improve postoperative related indicators, reduce levels of inflammatory factors, promote recovery, and safety is relatively high.

     

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