目的 探索美羅培南聯(lián)合醒腦靜注射液治療小兒化膿性腦膜炎的臨床療效和安全性。方法 選取2012年6月—2015年1月綿陽(yáng)市人民醫(yī)院兒科收治的小兒化膿性腦膜炎患兒104例, 隨機(jī)分為對(duì)照組和治療組, 每組52例。對(duì)照組患兒給予醒腦靜注射液0.3~0.5 mL/(kg·d)加入5%或10%葡萄糖注射液50 mL稀釋后靜脈滴注, 同時(shí)靜脈滴注注射用頭孢他啶100 mg/(kg·d), 每隔12 h一次。治療組患兒給予醒腦靜注射液, 用法用量同對(duì)照組, 同時(shí)靜脈滴注注射用美羅培南, 120 mg/(kg·d), 每隔8 h一次。兩組均連續(xù)治療7 d。觀察兩組的臨床療效, 同時(shí)比較兩組患兒臨床癥狀、體征改善時(shí)間以及血清、腦脊液中腫瘤壞死因子-α(TNF-α)、C反應(yīng)蛋白(CRP)的變化。結(jié)果 治療后, 對(duì)照組和治療組的總有效率分別為75.00%、94.23%, 兩組總有效率比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療組患兒體溫下降時(shí)間、顱高壓消失時(shí)間、驚厥持續(xù)時(shí)間、意識(shí)恢復(fù)時(shí)間、腦脊液恢復(fù)正常時(shí)間均較對(duì)照組相應(yīng)減少, 兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后, 兩組患者血清及腦脊液TNF-α、CRP水平均較同組治療前顯著降低, 同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組的降低程度優(yōu)于對(duì)照組, 兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 美羅培南聯(lián)合醒腦靜注射液治療小兒化膿性腦膜炎療效顯著, 安全性高, 可作為臨床治療的優(yōu)選方案, 值得進(jìn)行推廣應(yīng)用。

Objective To explore the efficacy and safety of meropenem combined with Xingnaojing Injectionin in treatment of infantile purulent meningitis. Methods Patients (104 cases) with infantile purulent meningitis in Mianyang People's Hospital from June 2012 to January 2015 were randomly divided into control and treatment groups, and each group had 52 cases. The patients in the control group were iv administered with Xingnaojing Injectionin 0.3—0.5 mL/(kg·d) dissolved in 5% or 10% glucose injection 50 mL, and they were iv administered with Ceftazidime for injection 100 mg/(kg·d), once every 12 h. The patients in the treatment group were iv administered with Xingnaojing Injectionin, and the usage and dosage were the same as the control group. The patients in the treatment group were iv administered with Meropenem for injection 120 mg/(kg·d), once every 8 h. Two groups were treated for 7 d. After treatment, the efficacy was evaluated, and improved time of clinical symptoms and signs, TNF-α and CRP of serum and cerebrospinal fluid in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 75.00% and 94.23%, respectively, and there were differences between two groups (P < 0.05). Body temperature drop time, intracranial hypertension disappear time, convulsion duration time, consciousness recovery time, and CSF recovery time in the treatment group were shorter than those in the control group, and there were differences between two groups (P < 0.05). TNF-α and CRP of serum and cerebrospinal fluid in two groups were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). Conclusion Meropenem combined with Xingnaojing Injectionin has good clinical efficacy in treatment of infantile purulent meningitis with high safety, and can be used as the preferred method of clinical treatment, which is worthy of popularization and application.