目的 探索美罗培南联合醒脑静注射液治疗小儿化脓性脑膜炎的临床疗效和安全性。方法 选取2012年6月—2015年1月绵阳市人民医院儿科收治的小儿化脓性脑膜炎患儿104例, 随机分为对照组和治疗组, 每组52例。对照组患儿给予醒脑静注射液0.3~0.5 mL/(kg·d)加入5%或10%葡萄糖注射液50 mL稀释后静脉滴注, 同时静脉滴注注射用头孢他啶100 mg/(kg·d), 每隔12 h一次。治疗组患儿给予醒脑静注射液, 用法用量同对照组, 同时静脉滴注注射用美罗培南, 120 mg/(kg·d), 每隔8 h一次。两组均连续治疗7 d。观察两组的临床疗效, 同时比较两组患儿临床症状、体征改善时间以及血清、脑脊液中肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)的变化。结果 治疗后, 对照组和治疗组的总有效率分别为75.00%、94.23%, 两组总有效率比较差异有统计学意义(P<0.05)。治疗组患儿体温下降时间、颅高压消失时间、惊厥持续时间、意识恢复时间、脑脊液恢复正常时间均较对照组相应减少, 两组比较差异有统计学意义(P<0.05)。治疗后, 两组患者血清及脑脊液TNF-α、CRP水平均较同组治疗前显著降低, 同组治疗前后差异有统计学意义(P<0.05);且治疗组的降低程度优于对照组, 两组比较差异有统计学意义(P<0.05)。结论 美罗培南联合醒脑静注射液治疗小儿化脓性脑膜炎疗效显著, 安全性高, 可作为临床治疗的优选方案, 值得进行推广应用。

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.