不同脑脊液引流方式对AIDS合并新型隐球菌脑膜炎患者颅高压预后影响
发布时间：2018-10-22 17:46
【摘要】：目的探讨艾滋病(AIDS)合并新型隐球菌脑膜炎伴颅内高压的治疗策略,以降低其病死率。方法对AIDS合并新型隐球菌脑膜炎伴颅高压症状的患者,在抗真菌治疗的基础上,分别采用反复腰椎穿刺、腰大池置管引流、ommaya囊引流、脑室腹腔分流,根据初始颅内压的水平比较不同脑脊液引流方式的治疗效果。结果共计调查AIDS合并新型隐球菌脑膜炎并颅内高压患者34例。颅内压200~249mmH2O的6例患者均痊愈;250~350mmH2O的9例患者中,8例痊愈,1例死亡;350mmH2O的19例患者中,13例痊愈,6例死亡。单纯采用反复腰椎穿刺的27例患者中,22例痊愈,5例死亡;采用外引流的4例患者中,2例痊愈,2例死亡;采用内引流的3例患者均痊愈。结论对于AIDS合并新型隐球菌脑膜炎伴颅内高压的患者,可根据初始颅内压水平采用不同的降颅内高压的策略。在充分抗真菌治疗的基础上,对合并恶性颅内高压的患者,建议尽早行腰大池、ommaya囊引流、脑室腹腔分流,以有效控制颅内高压,提高临床疗效,降低病死率。
[Abstract]:Objective to explore the treatment strategy of (AIDS) combined with Cryptococcus neoformans meningococcal meningitis with intracranial hypertension in order to reduce the mortality. Methods the patients with AIDS complicated with Cryptococcus neoformans meningitis accompanied with cranial hypertension were treated with repeated lumbar puncture, lumbar cistern drainage, ommaya capsule drainage and intraventricular and abdominal shunt respectively on the basis of antifungal therapy. The therapeutic effects of different cerebrospinal fluid drainage methods were compared according to the level of initial intracranial pressure. Results A total of 34 patients with AIDS complicated with cryptococcal meningitis and intracranial hypertension were investigated. Of the 9 patients with 250~350mmH2O, 8 recovered and 1 died, and of the 19 350mmH2O patients, 13 recovered and 6 died. Of the 27 patients with recurrent lumbar puncture, 22 were cured and 5 died, 2 were cured and 2 died of external drainage, and 3 were cured by internal drainage. Conclusion for patients with AIDS complicated with Cryptococcus neoformans meningitis with intracranial hypertension, different strategies of lowering intracranial hypertension can be adopted according to the level of initial intracranial pressure. On the basis of adequate antifungal therapy, it is suggested that the patients with malignant intracranial hypertension should be treated with lumbar cistern, ommaya sac drainage and intraventricular and peritoneal shunt as early as possible in order to effectively control intracranial hypertension, improve clinical efficacy and reduce mortality.
【作者单位】： 杭州市西溪医院感染二科;
【基金】：杭州市科技局项目(20170533B81)~~
【分类号】：R519.4
本文编号：2287872
[Abstract]:Objective to explore the treatment strategy of (AIDS) combined with Cryptococcus neoformans meningococcal meningitis with intracranial hypertension in order to reduce the mortality. Methods the patients with AIDS complicated with Cryptococcus neoformans meningitis accompanied with cranial hypertension were treated with repeated lumbar puncture, lumbar cistern drainage, ommaya capsule drainage and intraventricular and abdominal shunt respectively on the basis of antifungal therapy. The therapeutic effects of different cerebrospinal fluid drainage methods were compared according to the level of initial intracranial pressure. Results A total of 34 patients with AIDS complicated with cryptococcal meningitis and intracranial hypertension were investigated. Of the 9 patients with 250~350mmH2O, 8 recovered and 1 died, and of the 19 350mmH2O patients, 13 recovered and 6 died. Of the 27 patients with recurrent lumbar puncture, 22 were cured and 5 died, 2 were cured and 2 died of external drainage, and 3 were cured by internal drainage. Conclusion for patients with AIDS complicated with Cryptococcus neoformans meningitis with intracranial hypertension, different strategies of lowering intracranial hypertension can be adopted according to the level of initial intracranial pressure. On the basis of adequate antifungal therapy, it is suggested that the patients with malignant intracranial hypertension should be treated with lumbar cistern, ommaya sac drainage and intraventricular and peritoneal shunt as early as possible in order to effectively control intracranial hypertension, improve clinical efficacy and reduce mortality.
【作者单位】： 杭州市西溪医院感染二科;
【基金】：杭州市科技局项目(20170533B81)~~
【分类号】：R519.4
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