静脉滴注联合鞘内注射盐酸去甲万古霉素对颅内感染患者的疗效分析

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1、授予单位代码10089学号或申请号16161中国图书分类号R619+.3HebeiMedicalUniversity硕士学位论文学术学位静脉滴注联合鞘内注射盐酸去甲万古霉素对颅内感染患者的疗效分析研究生：程扬导师：赵宗茂教授专业：外科学二级学院：河北医科大学第二医院2018年3月目录中文摘要··········································································································1英文摘要···········································

2、································································3研究论文静脉滴注联合鞘内注射盐酸去甲万古霉素对颅内感染患者的疗效分析前言····································································································6材料与方法·····················································································6结果·····

3、····································································································10附表·····································································································14讨论···························································································

4、···············17结论····································································································25参考文献·······················································································25综述神经外科颅脑术后颅内感染的防治研究进展··································29致谢···························

5、····································································43个人简历·········································································································44静脉滴注联合鞘内注射盐酸去甲万古霉素对颅内感染患者的疗效分析摘要颅内感染是神经外科开颅术后比较严重的并发症之一，一旦发生，不仅大大降低患者原疾病的疗效，甚至危及患者生命。由于患者术前普遍预防性使用了抗生素，脑脊液细菌培养结果和涂片多数为阴

6、性，无法准确选择有效抗菌素，医师只能经验性选用万古霉素联合美罗培南、头孢曲松等治疗颅内感染。但万古霉素(稳可信)价格较高，且治疗周期较长，很多患者难以承受。在多年临床研究的基础上，发现盐酸去甲万古霉素对革兰阳性球菌(金葡菌、链球菌、肠球菌)有良好的抗菌作用，且价格低廉。本课题探讨采用静脉滴注联合鞘内注射盐酸去甲万古霉素治疗颅内感染患者，其疗效与应用万古霉素(稳可信)的疗效相仿，因此，采用盐酸去甲万古霉素治疗术后颅内感染，其疗效可替代万古霉素(稳可信)。目的：探讨颅内感染患者静脉滴注联合鞘内注射盐酸去甲万古霉素的疗效、安全性及最佳给药剂量、给药方法。方法：经北京燕化医院伦理委员会批准，患者对鞘内

7、注药知情同意并签署知情同意书，选取2013年2月-2018年2月北京燕化医院神经外科60例神经外科开颅术后并发颅内感染患者资料。观察组30例静脉滴注盐酸去甲万古霉素0.8g每12小时一次，对照组30例静脉滴注万古霉素(稳可信)1.0g每12小时一次，两组均同时联合三代头孢或美罗培南，在监测颅内压情况下腰穿或持续腰大池置管引流，缓慢放出脑脊液10-20ml后鞘内注入生理盐水10ml+盐酸去甲万古霉素