改良腰池引流配合持续鞘内注射两性霉素B治疗隐球菌脑膜炎

发布时间：2018-05-28 09:56

本文选题：腰大池引流 + 隐球菌　；参考：《广东医学》2015年23期

【摘要】：目的探讨改良腰池引流配合持续鞘内注射两性霉素B(AMB)治疗隐球菌脑膜炎效果。方法将30例隐球菌脑膜炎患者分为观察组和对照组,每组15例。观察组采用改良腰池引流技术,持续引流脑脊液,并在全身抗真菌治疗基础辅予微量泵缓慢鞘内注射AMB。对照组在全身抗真菌治疗基础上每周2~3次腰穿,每次腰穿放脑脊液5~10 m L,同时鞘内注射AMB。结果两组治疗2周后症状体征疗效观察、脑脊液墨汁染色转阴时间、使用AMB剂量、鞘内给药不良反应比较差异有统计学意义(P0.05),观察组优于对照组而脑脊液细胞数、糖、氯、蛋白指标变化、脑脊液隐球菌培养转阴时间、并发感染差异无统计学意义(P0.05)。结论对于并发恶性颅高压隐球菌脑膜炎患者采用改良腰池引流配合持续鞘内注射AMB可提高隐球菌脑膜炎治疗的有效率,加快病原清除和症状恢复,缩短住院时间,同时显著减少鞘内注射引起瘫痪、肢体麻木、尿潴留等恶性不良事件。
[Abstract]:Objective to investigate the effect of modified lumbar cistern drainage combined with continuous intrathecal injection of amphotericin (AMB) in the treatment of Cryptococcus meningitis. Methods 30 patients with Cryptococcus meningitis were divided into observation group and control group with 15 cases in each group. In the observation group, modified lumbar cistern drainage technique was used to continuously drain cerebrospinal fluid (CSF), and AMB was injected slowly into the sheath of micropump on the basis of systemic antifungal therapy. In the control group, on the basis of systemic antifungal therapy, lumbar puncture was performed three times a week, and CSF was put into cerebrospinal fluid (CSF) 510m / L each time, and AMB was injected intrathecally. Results after 2 weeks of treatment, there were significant differences between the two groups in the effect of symptoms and signs, the time of negative staining of cerebrospinal fluid ink, the dosage of AMB and the adverse reaction of intrathecal administration. The observation group was superior to the control group in the number of cerebrospinal fluid cells, sugar and chlorine. There was no significant difference in the change of protein index, the time of negative culture of Cryptococcus in cerebrospinal fluid and the complication of infection (P 0.05). Conclusion the modified lumbar cistern drainage combined with continuous intrathecal injection of AMB in patients with cryptococcal meningitis complicated with malignant cranial hypertension can improve the effective rate of treatment of Cryptococcus meningococcal meningitis, accelerate the pathogen clearance and symptoms recovery, and shorten the hospital stay. At the same time, malignant adverse events such as paralysis, limb numbness and urinary retention were significantly reduced by intrathecal injection.
【作者单位】：江西省胸科医院神经内科;江西省黄庆仁药店;江西省南昌市第七医院内科;
【基金】：江西省科技支撑计划项目(编号:20121BBG70046)
【分类号】：R519.4

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