治疗重度脑囊尾蚴病的临床研究  

Clinical Study on the Treatment of Severe Neurocysticercosis

作　　者：袁治[1] 任海军[2] 丁永忠[2] 张建生[2] 吴小璐[1] 王维平[1] 裘明德[2] 

机构地区：[1]兰州医学院第二附属医院脑研病房,兰州730030 [2]兰州医学院第二附属医院神经外科,兰州730030

出　　处：《中国寄生虫学与寄生虫病杂志》2004年第4期213-217,共5页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：甘肃省教育委员会科研项目 (0 2B3 1 8)~~

摘　　要：目的　探讨阿苯达唑减量法及外科降颅压措施治疗重度脑囊尾蚴病的方法。　方法　 74例重度脑囊尾蚴病患者经脑CT和 /或磁共振成像 (MRI)证实囊尾蚴数为 10 0～ 1160个。先用阿苯达唑减量法找到初始耐受剂量 ,之后逐渐递增到治疗剂量 (口服阿苯达唑每天 2 0mg/kg ,分 3次服用 ,10d为 1疗程 ,共 3～ 4疗程 )。服药治疗期间同时用降颅压药物和抗癫痫药。使用药物降颅压无效者行外科降颅压治疗。　结果　 74例患者服用阿苯达唑后 ,经药物降颅压有效者 7例 ,无效者 67例。无效者 ,经脑室外引流术治疗 48例 ,脑室外引流加颞肌减压术治疗 19例。 67例经手术降颅压治疗的患者 ,除 1例外皆可耐受阿苯达唑治疗。 74例患者中随访 70例 ,随访期为 19～ 5 2个月 (平均3 7 2月 )。随访中经复查CT或MRI ,除 1例 (囊尾蚴数达 1160个 )治疗失败外 ,其余 69例均临床治愈。　结论　阿苯达唑减量法并行降颅压药物或外科降颅压治疗重度脑实质囊尾蚴病 ,是安全。Objective To determine the therapeutic efficacy of albendazole combined with surgical intervention on intracranial hypertension in the treatment of severe neurocysticercosis. Methods\ Seventy\|four consecutive patients with severe neurocysticercosis were confirmed by neuroimaging techniques(CT and/or MRI) and ELISA for the detection of antibody to cysticerci of Taenia solium. The number of cysticerci in the brain ranged from 100 to \{1 160\}. All patients were treated with albendazole by dose\|decreasing regimen. Initial tolerable dosage was defined by dose\|decreasing progressively, depending on the total number of cysticerci; then the dose of albendazole was increased progressively, and ultimate dosage was 20 mg per kilogram of body weight daily. Albendazole was taken for 3-4 courses(10 days as a course). Drugs to reduce intracranial pressure were used in all patients during the treatment, including mannitol, corticosteroids and/or sodium escin. 67 patients with intracranial hypertension were treated with surgical treatment, including drainage of cerebral ventricle and/or decompression of temporal muscle. All patients received antiseizure medications to prevent the onset of seizures during the treatment. \ Results \ The combination of albendazole and surgical intervention was curative in 69 of 74 patients with neurocysticercosis after a follow\|up of an average 37\^2 (19-52) months. CT and/or MRI examination demonstrated that the cysts had disappeared or become calcified. Only 1 case failed because there were \{1 160\} cysts in the brain of the patient. \ Conclusion \ The combination of albendazole and surgical maneuvers to reduce intracranial pressure is a safe and effective method for treating severe neurocysticercosis.

关 键 词：治疗 降颅压 阿苯达唑 重度 脑囊尾蚴病 患者 外科 疗程 药物 施治 

分 类 号：R532[医药卫生—内科学] R735.7[医药卫生—临床医学]