鞘内注射抗生素对于新生儿难治性化脓性脑膜炎的有效性和安全性分析
Analysis of the Efficacy and Safety of Intrathecal Antibiotic Injection as an Adjunctive Treatment for Neonatal Refractory Purulent Meningitis
DOI: 10.12677/acm.2026.161030, PDF,   
作者: 黄千景：重庆医科大学附属儿童医院新生儿科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，重庆；韦 红*：重庆医科大学附属儿童医院新生儿科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室；儿童神经发育与认知障碍重庆市重点实验室，重庆
关键词: 新生儿难治性化脓性脑膜炎；鞘内注射；抗生素；Neonates Refractory Purulent Meningitis； Intrathecal Injection； Antibiotics
摘要: 新生儿难治性化脓性脑膜炎是新生儿时期严重的中枢神经系统感染性疾病，大多数患者预后不良，存活患者常遗留严重神经系统后遗症。鞘内注射作为一种抗感染辅助治疗方式可直接越过血脑屏障达到有效抗菌浓度。但目前尚不清楚关于鞘内注射抗生素治疗新生儿难治性化脓性脑膜炎的有效性及安全性。本文从新生儿难治性化脓性脑膜炎行鞘内注射抗生素治疗的有效性和安全性方面进行分析，探讨鞘内注射抗生素治疗方式的临床价值，为最终的医疗决策提供循证依据。
Abstract: Neonatal refractory purulent meningitis is a severe infectious disease in the neonatal period, characterized by high mortality. Survivors often suffer from severe neurological sequelae. As an adjuvant anti-infective therapy, intrathecal injection can directly cross the blood-brain barrier to achieve effective antibacterial concentrations. However, the efficacy and safety of intrathecal antibiotic injection in the treatment of neonatal refractory purulent meningitis remain unclear. This article analyzes the efficacy and safety of intrathecal antibiotic administration for this disease, aiming to improve clinicians’ understanding of this therapeutic approach and thereby provide a reference for clinical decision-making.
文章引用：黄千景, 韦红. 鞘内注射抗生素对于新生儿难治性化脓性脑膜炎的有效性和安全性分析[J]. 临床医学进展, 2026, 16(1): 209-213. https://doi.org/10.12677/acm.2026.161030

参考文献

[1] Galiza, E.P. and Heath, P.T. (2009) Improving the Outcome of Neonatal Meningitis. Current Opinion in Infectious Diseases, 22, 229-234. [Google Scholar] [CrossRef] [PubMed]
[2] 赵智, 华雪莹, 张海波, 等. 新生儿化脓性脑膜炎诊疗现状和预后的多中心调查研究[J]. 中华新生儿科杂志, 2018, 33(1): 2-6.
[3] 周敏丽, 陈丽萍, 蒋文星, 等. 新生儿难治性化脓性脑膜炎诊治进展[J]. 中华新生儿科杂志, 2025, 40(4): 242-246.
[4] 李淑涓, 乔中伟, 蒋思远, 等. 新生儿难治性化脓性脑膜炎临床及影像学特点分析[J]. 中华围产医学杂志, 2016, 19(5): 377-384.
[5] 王苏平, 赵耿义, 王平. 脑脊液置换配合鞘内给药治疗化脓性脑膜炎[J]. 中华急诊医学杂志, 2007, 16(1): 54-56.
[6] Yeung, C.Y. (1976) Intrathecal Antibiotic Therapy for Neonatal Meningitis. Archives of Disease in Childhood, 51, 686-690. [Google Scholar] [CrossRef] [PubMed]
[7] 中华医学会儿科学分会感染学组, 中华儿科杂志编辑委员会. 儿童细菌性脑膜炎并发症诊疗专家共识[J]. 中华儿科杂志, 2023, 61(2): 108-116.
[8] 阎贝贝, 晓莺. 新生儿难治性化脓性脑膜炎的临床分析[J]. 中国医药指南, 2018, 16(1): 14-18.
[9] Kim, K.S. (2010) Acute Bacterial Meningitis in Infants and Children. The Lancet Infectious Diseases, 10, 32-42. [Google Scholar] [CrossRef] [PubMed]
[10] Peng, H., Hu, Y., Chen, H., Song, P. and Jiang, L. (2018) Risk Factors for Poor Prognosis in Children with Refractory Purulent Meningitis and the Discharge Criteria. Journal of Infection and Public Health, 11, 238-242. [Google Scholar] [CrossRef] [PubMed]
[11] 潘海涛. 地塞米松辅助抗感染治疗对小儿难治性化脓性脑膜炎的疗效分析[J]. 中华医院感染学杂志, 2018, 28(14): 2189-2192.
[12] Jiang, Z.F., Shen, K.L. and Shen, Y. (2015) Zhu Futang Practical Pediatrics. 8th Edition, People’s Health Publishing House.
[13] Nau, R., Blei, C. and Eiffert, H. (2020) Intrathecal Antibacterial and Antifungal Therapies. Clinical Microbiology Reviews, 33, e00190-19. [Google Scholar] [CrossRef] [PubMed]
[14] Anonymous (1976) Intrathecal Antibiotics in Purulent Meningitis. The Lancet, 308, 1068.
[15] Spader, H.S., Hertzler, D.A., Kestle, J.R.W. and Riva-Cambrin, J. (2015) Risk Factors for Infection and the Effect of an Institutional Shunt Protocol on the Incidence of Ventricular Access Device Infections in Preterm Infants. Journal of Neurosurgery: Pediatrics, 15, 156-160. [Google Scholar] [CrossRef] [PubMed]
[16] Ambreen, G., Salat, M.S., Hussain, K., Raza, S.S., Ali, U., Azam, I., et al. (2020) Efficacy of Colistin in Multidrug-Resistant Neonatal Sepsis: Experience from a Tertiary Care Center in Karachi, Pakistan. Archives of Disease in Childhood, 105, 830-836. [Google Scholar] [CrossRef] [PubMed]
[17] McCracken, G.H. and Mize, S.G. (1976) A Controlled Study of Intrathecal Antibiotic Therapy in Gram-Negative Enteric Meningitis of Infancy. The Journal of Pediatrics, 89, 66-72. [Google Scholar] [CrossRef] [PubMed]
[18] Gray, J.W., Ubhi, H. and Milner, P. (2014) Antimicrobial Treatment of Serious Gram-Negative Infections in Newborns. Current Infectious Disease Reports, 16, Article No. 400. [Google Scholar] [CrossRef] [PubMed]
[19] Mrowczynski, O.D., Langan, S.T. and Rizk, E.B. (2018) Intra-Cerebrospinal Fluid Antibiotics to Treat Central Nervous System Infections: A Review and Update. Clinical Neurology and Neurosurgery, 170, 140-158. [Google Scholar] [CrossRef] [PubMed]
[20] Remeš, F., Tomáš, R., Jindrák, V., Vaniš, V. and Šetlík, M. (2013) Intraventricular and Lumbar Intrathecal Administration of Antibiotics in Postneurosurgical Patients with Meningitis and/or Ventriculitis in a Serious Clinical State. Journal of Neurosurgery, 119, 1596-1602. [Google Scholar] [CrossRef] [PubMed]
[21] Muller, A.E., van Vliet, P. and Koch, B.C.P. (2023) Clinical Experience with Off-Label Intrathecal Administration of Selected Antibiotics in Adults: An Overview with Pharmacometric Considerations. Antibiotics, 12, Article No. 1291. [Google Scholar] [CrossRef] [PubMed]
[22] Wilson, G., Rupp, C. and Wilson, W.W. (1949) The Dangers of Intrathecal Medication. JAMA: The Journal of the American Medical Association, 140, 1076-1079. [Google Scholar] [CrossRef] [PubMed]
[23] Brotis, A.G., Churis, I. and Karvouniaris, M. (2019) Local Complications of Adjunct Intrathecal Antibiotics for Nosocomial Meningitis Associated with Gram-Negative Pathogens: A Meta-Analysis. Neurosurgical Review, 44, 139-152. [Google Scholar] [CrossRef] [PubMed]

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