| Intracranial infection is one of the most serious complications of neurosurgical craniotomy.Once it occurs,it not only greatly reduces the effect of the patient's original disease,even threats the lives of patients.Due to widespread clinical prophylactic use of antibiotics before surgery,cerebrospinal fluid bacterial culture results and smears were mostly negative and could not accurately select effective antibiotics.Physicians can only apply vancomycin combined with meropenem or ceftriaxone for the treatment of intracranial infections empirically.But the price of vancomycin(stable and reliable)is high,and the treatment cycle is long,and many patients can't bear it.Recent clinical studies show that the antibacterial effect of methyvanc-omycin hydrochloride to gram-positive cocci(staphylococcus aureus,streptococcus and enterococcus)was good,and the price was low.In this study,intravenous injection of hydrochloric acid was used to treat patients with intracranial infection.Its efficacy is similar to that of vancomycin(stable and reliable).Therefore,the treatment of postoperative intracranial infection with hydrochloric acid was performed,and its efficacy could replace vancomycin(stable and reliable).Objective:To explore the efficacy,safety and optimal dosage and administration of intravenous injection of hydrochloric acid in patients with intracranial infection.Methods:After approval by the ethics committee of Beijing Yanhua Hospital,patients signed informed consent.Selected patients with intracranial infections after neurosurgical craniotomy from February 2013 to February2018 at the Department of Neurosurgery,Beijing Yanhua Hospital.Observation group,the intravenous drip of hydrochloric acid was used for0.8g of mevancomycin for every 12 hours,and the control group iv infusion of vancomycin(stable and reliable)1.0g was once every 12 hours.Both groups were combined with three generations of cephalosporin or meropenem.In the monitoring of the intracranial pressure,or continuous lumbar cistern drainage,slowly release the cerebrospinal fluid from 10 to 20ml and intrathecal injection inject the 10ml normal saline and hydrochloric acid to mevanco-mycin or vancomycin(stable and reliable),hydrochloric acid to mevancomycin or vancomycin(stable and reliable)is from 5mg,according to the changes of cerebrospinal fluid,the dose of drug administration was gradually increased,with each increase of 5mg daily.In this study,the minimum effective treatment dose for mevancomycin hydrochloride was 10mg and the maximum effective dose was 30mg;The minimum effective dose of vancomycin(stable and reliable)was 10mg and the maximum effective dose was 35mg.Until the leukocyte of cerebrospinal fluid is reduced to 10-20×10~6/L,three consecutive CSF tests were maintained at around 10-20×10~6/L.Results:Among 60 cases of intracranial infection,30 cases in the observation group were treated with norvancomycin hydrochloride,and 30cases in the control group were treated with vancomycin(stable and reliable).In the treatment of cerebrospinal fluid(WBC),total protein content(Pro),sugar content(Glu)and chloride content(Cl-),the observation group were(194.50+82.89)x 10~6/L,(1122.50+778.68)mg/L,(2.98+0.91)mmol/L,(131.84+10.20)mmol/L,and the control group were(225.70+100.29)x 106/L,(1033.41+598.70)mg/L,(3)46+0.76)mmol/L,(131.49+11.45)mmol/L,and there was no significant difference in the above changes between the two groups(P>0.05).Compared with two groups of white blood cells(WBC)in the peripheral blood,the observation group was(11.80+3.77)x 106/L,the control group(10.82+4.27)x 10~6/L,and the two groups had no significant difference in the reduction of WBC in the peripheral blood(P>0.05).The comparison between the two groups of WBC,Pro,Glu and Cl-in cerebrospinal fluid after treatment were(16.12+7.06)x 106/L,(650.24+132.57)mg/L,(3.89+0.49)mmol/L and(132.38+10.06)mmol/L in observa-tion group,and the control groups were respectively(22.90+14.08)x 106/L,(604.38+184.42)mg/L,(3.91+3.89)mmol/L,and mmol/L,there was no significant difference between the two groups after treatment(P>0.05);compared with the WBC of the peripheral blood in two groups after treatment,the observation group(5.92+2.71)x 10~6/L,the control group(7.36+1.36)x10~6/L,the two groups had no significant difference(P>0.05)in the peripheral blood after the treatment.In the observation group,16 cases were cured,8cases were markedly effective,3 cases were progresses,the total effective rate was 90%,the control group 18 cases of recovery,6 cases had marked effect,progress in 4 cases,the total effective rate was 93.33%,the total curative effect of two groups of patients had no significant difference(P>0.05).Conclusion:Intracranial infection patients were treated with intravenous drip combined with intrathecal injection of norvancomycin hydrochloride,compared with intravenous drip intrathecally with vancomycin(stable and reliable),the same effect was achieved in improving WBC,Pro,Glu,Cl-of cerebrospinal fluid and WBC of peripheral blood,... |
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