鞘内输注系统持续引流脑脊液对癌性脑膜炎伴颅内压升高患者的疗效观察

发布时间：2018-06-17 18:53

  本文选题：癌性脑膜炎 + 鞘内输注系统　； 参考：《福建医科大学》2015年硕士论文

【摘要】：背景:癌性脑膜炎,作为肿瘤全身转移最严重的并发症,患者常死于进行性神经病变,预后极差。目前以姑息治疗为主,并无统一的治疗方案。文献报道一致认为早期诊断、早期治疗可以最大化保存神经功能,而且显著提高生存质量。因此,提高对本病的认识,并及早诊断治疗将成为临床工作的一大研究课题。目的:癌性脑膜炎目前尚无有效治疗方案,以姑息治疗为主,包括全脑放射治疗,鞘内化疗,全身化疗等,但疗效差。癌性脑膜炎主要引起颅内高压破坏神经功能,治疗原则是尽可能地改善或者稳定神经功能,延长生存期,提高生活质量。通过观察鞘内输注系统持续引流脑脊液对癌性脑膜炎伴颅内压升高患者的临床疗效,为癌性脑膜炎的治疗提供临床参考。方法:1.病例收集病例来源于南京军区福州总医院第四七六临床部肿瘤科于2013年3月1日至2014年12月31日收治的并且应用鞘内输注系统引流脑脊液的16例癌性脑膜炎伴有颅内压升高患者。16例患者中,男性7例(43.75%),女性9例(56.25%);年龄39-70岁,平均年龄53.1岁。16例患者全部明确肿瘤病史,有相应的临床以及影像学表现,并经过脑脊液细胞学检查确诊。2.治疗方法16例患者因病情因素及机体原因未能进一步行专科治疗,均行最佳支持治疗(BSC)。术前给予地塞米松、甘油果糖、甘露醇等脱水剂进行脱水降颅压保守治疗,效果并不理想。完善术前准备后,行鞘内输注系统植入术持续引流脑脊液,缓解颅内压升高症状。3.评价一周后评价患者临床疗效评估,卡氏评分及生活质量评估,心理状态评估,并统计患者的生存时间。4.统计学方法所得数据均采用SPSS17.0软件进行统计。采用双侧检验的假设检验,P≤0.05被认为所检验的差异有统计学意义。可信区间采用95%的可信度。采用Wilcoxon秩和检验分析患者的KPS评分平均值改变及QOL、SAS评分。用Kaplan-Meier方法绘制生存函数。结果:1.16例患者中,1例失访,随访率达到93.75%。其中1例患者死于脑卒中。行卡氏评分,术后患者均有不同程度的升高且维持一段时间。之后随病情恶化逐步降低。手术后患者的临床症状,如头痛、恶心、呕吐,意识障碍等显著改善,术后随访1周患者的K氏评分比术前显著提高,并且可维持一段时间。生活质量评分以及心理状态明显改善。2.从患者诊断癌性脑膜炎开始计算生存期,完成治疗后,后续随访生存48周的1例(6.25%),24-48周的0例(0%),12-24周的2例(12.50%),4-12周的6例(37.50%),4周的6例(37.50%)。患者中位生存期8.30周(95%CI,2.11-14.49)。与目前文献资料报道的中位生存期4-6周相比,能延长患者生存期。结论:1.鞘内输注系统能够缓解颅内压升高,显著改善患者的临床症状,提高患者的生存质量。2.患者生存期延长,但样本数较少,需进一步证实。
[Abstract]:Background: carcinomatous meningitis, as the most serious complication of tumor metastasis, often dies of progressive neuropathy and its prognosis is very poor. At present, palliative treatment is the main treatment, and there is no unified treatment plan. Literature reports agree that early diagnosis and treatment can maximize the preservation of neural function and significantly improve the quality of life. Therefore, improving the understanding of the disease and early diagnosis and treatment will become a major research topic in clinical work. Objective: there is no effective treatment for carcinomatous meningitis. Palliative therapy is the main treatment, including whole brain radiotherapy, intrathecal chemotherapy, systemic chemotherapy and so on, but the curative effect is poor. The treatment principle is to improve or stabilize the nerve function as far as possible, prolong the survival period and improve the quality of life. To observe the clinical effect of continuous drainage of cerebrospinal fluid (CSF) by intrathecal infusion system in patients with carcinomatous meningitis associated with elevated intracranial pressure, and to provide clinical reference for the treatment of carcinomatous meningitis. Method 1: 1. Cases were collected from 16 cases of carcinomatous meningitis associated with cerebrospinal fluid drainage using intrathecal infusion system from March 1, 2013 to December 31, 2014, Department of Oncology, Clinical Department No. 476, Fuzhou General Hospital of Nanjing military region. Of the 16 patients with elevated intracranial pressure, The age was 39-70 years old, the average age was 53.1 years old. All the 16 patients had definite tumor history, had corresponding clinical and imaging manifestations, and were diagnosed by cerebrospinal fluid cytology. Methods 16 patients were treated with the best support therapy because of the disease condition and the organism reason. Preoperative dehydration and intracranial pressure reduction with dexamethasone, fructose and mannitol were not satisfactory. After the preoperative preparation was improved, continuous drainage of cerebrospinal fluid was performed with intrathecal infusion system to relieve the symptoms of intracranial pressure elevation. A week later, the patients were evaluated for their clinical efficacy, Karnoff score and quality of life assessment, psychological status assessment, and survival time of the patients. 4. 4. SPSS 17.0 software was used to analyze the data obtained by statistical methods. Using the hypothesis test of bilateral test P 鈮，

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