神经重症患者中枢神经系统感染多黏菌素局部应用的中国专家共识（2024年版）

中华神经医学杂志2024年2月第23卷第2期Chin J Neuromed,February2024Vol.23,No.2·109··专家共识·神经重症患者中枢神经系统感染多黏菌素局部应用的中国专家共识(2024年版)中国医师协会神经外料分会神经重症专家委员会中国神经外料重症管理协作组道信作者：石广志，首都医科大学附属北京天坛医院重症医学科，北京100070，Email:shiguangzhi@bjth.org;冯光，河南省人民医院（郑州大学人民医院）神经外科，郑州450003，Email:fengguang@zzu.cdu.cn【摘要】神经重症患者中枢神经系统感染治疗难度大、病死率高，多重耐药革兰阴性杆菌感染占比逐年升高。多黏菌素是治疗多重耐药革兰阴性杆菌的有效药物，但其血脑屏障通过率低，静脉给药难以达到有效的药物浓度，脑室内或鞘内给药等局部应用的方式近年来越来越多地被临床采用，但缺乏相关的规范化操作指引，故本共识专家委员会围绕多黏菌素局部应用治疗中枢神经系统感染的适应证、用法用量、治疗途径等问题进行反复讨论，形成14条共识推荐意见，以期为多黏菌素中枢神经系统局部应用提供科学和切实可行的临床指导。【关键词】神经重症；中枢神经系统感染；多黏菌素；鞘内给药；脑室内给药基金项目：河南省科技厅医学科技攻关项目(202302311183)：北京市医院管理中心“扬帆”重点医学专业发展计划(ZYLX202109)】D0I:10.3760/cma.i.cn115354-20240124-00069Consensus of Chinese experts on topical application of polymyxin in severe central nervoussystem infections (2024)Neurological Intensive Care Expert Committee of Neurosurgical Branch of Chinese MedicalAssociation:China Neurosurgical Intensive Care Management Collaborative GroupCorresponding author:Shi Guangzhi,Department of Critical Care.Beijing Tiantan Hospital Affliatedto Capital Medical University:Beijing 100070.China.Email:shiguangzhi@bjth.org:Feng Guang.Department of Neurosurgery,He'nan Provincial People's Hospital (People's Hospital of ZhengzhouUniversity),Zhengzhou 450003.China,Email:fengguang@zu.edu.cn[Abstract]Treatment of severe central nervous system infections in patietns with neurologicalsevere diseases is difficult,with high mortality rate.Proportion of multidrug-resistant Gram negativebacteria has been increasing year by year.Polymyxin is an effective drug for multidrug-resistant Gramnegative bacteria,but its blood-brain barrier permeability is low,making it difficult for intravenousadministration to achieve effective drug concentration.Topical applications such asintracerebroventricular or intrathecal administrations have been increasingly used in clinical practice inrecent years,but lack relevant standardized guidelines.Therefore,the expert committee of thisconsensus has repeatedly discussed the indications,dosage,and treatment routes of topical applicationof polymyxin in central nervous system infections,and has formed 14 consensus recommendations,with a view to provide scientific and practicable clinical guidance for standardized topical applicationof polymyxin in central nervous system.Key words)Neurocritical disease;Central nervous system infection;Polymyxin;Intrathecal administration;Intraventricular administrationFund program:Medical Science and Technology Research Project of Henan ProvincialDepartment of Science and Technology (202302311183);Hospital Key Medical Development-"Yangfan"Project of Beijing Municipal Administration(ZYLX202109)D0:10.3760/cma.j.cn115354-20240124-00069