脑脊液置换联合鞘内注药治疗中晚期结核性脑膜炎临床疗效分析  

The clinical curative effect analysis of cerebrospinal fluid replacement combined with intrathecal injection in the treatment of middle and late tuberculous meningitis

作　　者：张春艳[1] 李毅[2] 池菲[1] 张秀敏[1] 孙金昊[3] 

机构地区：[1]河北省胸科医院急诊科,石家庄050000 [2]河北省胸科医院呼吸科,石家庄050000 [3]河北省胸科医院结核科,石家庄050000

出　　处：《疑难病杂志》2017年第8期805-808,812,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察脑脊液置换联合鞘内注药治疗中晚期结核性脑膜炎的临床疗效。方法选择2013年1月—2016年7月河北省胸科医院急诊科、呼吸科、结核科收治的中晚期结核性脑膜炎患者125例作为研究对象,采用数字表法随机分为3组,对照组41例,给予常规抗结核治疗;观察1组42例,在常规治疗基础上进行蛛网膜下腔注药治疗,2~3次/周;观察2组42例,在常规治疗基础上给予脑脊液置换加蛛网膜下腔注药治疗,2~3次/周。治疗2个月后,观察3组疗效,比较3组临床症状恢复时间和颅压恢复时间,并对3组的脑脊液蛋白、葡萄糖、氯化物及细胞数的恢复情况进行比较,观察患者的脑脊液DNA阳性率及脑电图恢复情况。结果观察2组总有效率为95.24%高于观察1组88.10%高于对照组70.73%(P<0.05或P<0.01)。3组临床症状缓解时间及颅内压恢复时间比较均有统计学差异(F=4.093、6.003,P<0.05),治疗2个月后3组脑脊液细胞数、蛋白、葡萄糖、氯化物比较均有显著差异(F=3.407、9.429、8.599、14.950,P<0.05)。与治疗前比较,观察2组脑脊液结核菌DNA阳性率降低(P<0.05),观察1组、2组脑电图均恢复,差异有统计学意义(P<0.05)。结论脑脊液置换联合鞘内注药治疗中重度结核性脑膜炎能促进症状的缓解,颅压、脑脊液生化指标改善,改善患者预后。Objective To observe the clinical efficacy of cerebrospinal fluid replacement combined with intrathecal injection in treatment of middle and late tuberculous meningitis.Methods One hundred and twenty five patients with moderate to severe tuberculous meningitis in department of emergency,respiratory and tuberculosis medicine in Hebei Chest Hospital from January 2013 to July 2016 were selected and they were randomly divided into three groups： the control group was given conventional treatment,while the study 1 group was given subarachnoid injection treatment on the basis of control group,2 to 3 times/week,and the study 2 group was given cerebrospinal fluid replacement combined with subarachnoid injection treatment on the basis of control group,2 to 3 times/week.After 2 months of treatment,we observed the effect in 3 groups.Compared three groups of symptoms recovery time and recovery time of intracranial pressure and observed the treatment effect after two months treatment.Among the three groups,cells in the cerebrospinal fluid,protein,glucose,chloride were compared.DNA in cerebrospinal fluid of patients with positive rate and recovery of electroencephalogram were observed.Results The total efficiency rate of study 2 group was 95.24%,which was better than the control group（70.73%）and study 1 group（88.10%）（P＆lt;0.05）.For the recovery time of clinical symptoms and intracranial pressure,there were statistically differences of the three groups（F=4.093,F=6.003,P=0.019,P=0.003）.The change of CSF cell count,protein,glucose,chloride after two months of treatment were showed significantly differences among the three groups（F=3.407,F=9.429,F=8.599,F=14.950,P=0.036,P=0.000,P=0.000,P=0.000）,positive rate of DNA in cerebrospinal fluid after treatment in study 2 group was statistically reduced（P=0.021）.The EEG recovery in study 1 and 2 group were statistical significant（P=0.003,P=0.000）.Conclusion Cerebrospinal fluid replacement combined with intrathecal injection in the treatment of severe tubercu

关 键 词：结核性脑膜炎 脑脊液置换 鞘内注药 疗效 

分 类 号：R529.3[医药卫生—内科学]