目的 探讨头孢噻肟钠联合万古霉素治疗小儿化脓性脑膜炎的临床疗效。方法 选取2017年6月—2018年6月在监利县人民医院治疗的化脓性脑膜炎患儿84例，根据用药的差别分为对照组（42例）和治疗组（42例）。对照组静脉滴注注射用盐酸万古霉素，10 mg/kg加入100 mL生理盐水，1次/6 h，每次持续60 min以上；治疗组在对照组基础上静脉滴注注射用头孢噻肟钠，75 mg/kg/次，1次/6 h。两组均治疗2周。观察两组患者临床疗效，同时比较治疗前后两组患者血清学指标、临床症状消失时间、脑脊液中神经营养因子和GCS评分。结果 治疗后，对照组临床有效率为80.95%，显著低于治疗组的97.62%，两组比较差异具有统计学意义（P<0.05）。经治疗，两组血清C反应蛋白（CRP）、降钙素原（PCT）、基质金属蛋白酶9（MMP-9）、白细胞介素1β（IL-1β）和白介素6（IL-6）水平均显著下降（P<0.05），且治疗组CRP、PCT、MMP-9、IL-1β、IL-6水平明显低于对照组（P<0.05）。治疗后，治疗组脑膜刺激征消失、体温恢复正常和颅内高压恢复正常时间均明显早于对照组（P<0.05）。经治疗，两组患儿脑脊液中胰岛素样生长因子-Ⅱ（IGF-Ⅱ）、神经元特异性烯醇化酶（NSE）、S100β表达水平均显著下降（P<0.05），且治疗组脑脊液中IGF-Ⅱ、NSE、S-100β水平明显低于对照组（P<0.05）。经治疗，两组GCS评分均显著升高（P<0.05），且治疗组GCS评分明显高于对照组（P<0.05）。结论 头孢噻肟钠联合万古霉素治疗小儿化脓性脑膜炎，可有效改善患儿临床症状、意识状态，降低机体炎症反应。

Objective To explore the clinical efficacy of cefotaxime sodium combined with vancomycin in treatment of children with purulent meningitis. Methods Children (84 cases) with purulent meningitis in Jianli County People's Hospital from June 2017 to June 2018 were divided into control (42 cases) and treatment (42 cases) groups based on different treatments. Children in the control group were iv administered with Vancomycin Hydrochloride for injection, 10 mg/kg added into normal saline 100 mL for more than 60 min, once every 6 h. Children in the treatment group were iv administered with Cefotaxime Sodium for injection on the basis of the control group, 75 mg/kg/time, once every 6 h. Children in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the serological indexes, the disappearance time of clinical symptoms, the neurotrophic factors of cerebrospinal fluid and GCS scores in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 80.95%, which was significantly lower than 97.62% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the serum CRP, PCT, MMP-9, IL-1β, and IL-6 levels in two groups were significantly decreased (P<0.05), and these serological indexes in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the disappearance time of meningeal irritation sign, the time of body temperature returned to normal and recovery of intracranial hypertension in the treatment group were significantly earlier than that in the control group (P<0.05). After treatment, the IGF-Ⅱ, NSE, S100β levels in cerebrospinal fluid in two groups were significantly decreased (P<0.05), and the neurotrophic factors levels in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the GCS scores in two groups were significantly increased (P<0.05), and which in the treatment group were significantly higher than that in the control group (P<0.05). Conclusion Cefotaxime sodium combined with vancomycin in treatment of children with purulent meningitis can effectively improve clinical symptoms and consciousness, and reduce inflammatory responses.