地塞米松联合异烟肼鞘内注射治疗结核性脑膜炎效果观察  

Effect Observation of Dexamethasone Combined with Isoniazid by Intrathecal Injection in Treatment of Patients with Tuberculous Meningitis

作　　者：李倩[1] 张建树[1] 孟艺哲 

机构地区：[1]保定市第一中心医院东院检验科,河北保定071000 [2]河北省胸科医院神经内科,石家庄050041

出　　处：《解放军医药杂志》2017年第11期80-83,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省青年科技课题(20150140)

摘　　要：目的探讨地塞米松联合异烟肼鞘内注射治疗结核性脑膜炎(TBM)的效果及对脑脊液的影响。方法选择保定市第一中心医院2015年3月—2017年2月收治的TBM 93例,按治疗方法分为观察组47例和对照组46例,两组均给予常规抗结核方案,对照组在此基础上给予地塞米松静脉滴注,观察组在对照组基础上给予地塞米松联合异烟肼鞘内注射。观察两组临床疗效、治疗前后脑脊液指标改善情况及临床症状和体征转归时间,并评价安全性。结果观察组总有效率高于对照组(P<0.05)。两组治疗后脑脊液氯化物和葡萄糖均较治疗前升高,细胞数和蛋白质均较治疗前降低,且观察组改善程度优于对照组(P<0.05,P<0.01)。观察组脑脊液指标恢复正常时间及临床症状体征转归时间均短于对照组(P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论地塞米松联合异烟肼鞘内注射治疗TBM能明显改善脑脊液常规水平,临床症状改善较快,且安全性较高。Objective To investigate effect of Dexamethasone combined with Isoniazid by intrathecal injection intreatment of patients with tuberculous meningitis （ TBM）and its effect on cerebrospinal fluid. Methods A total of 93TBM patients admitted during March 2015 and February 2017 were divided into observation group （ n = 47）and controlgroup （ n = 46）according to different treatments. All patients received routine antituberculosis treatment. Control groupwas treated with Dexamethasone by intravenous infusion,while observation group was treated with Dexamethasone by intravenous infusion combined with Isoniazid by intrathecal injection. In two groups,changes of cerebrospinal fluid indexes,returning to normal times of clinical sings and symptoms before and after treatment were observed,and safety was also evaluated. Results The total effective rate in observation group was significantly higher than that in control group（ P 〈0. 05） . After treatment,chlorides and glucose levels in cerebrospinal fluid were significantly increased,while cell numbers and protein levels were significantly decreased compared with those before treatment in two groups,and the improvement conditions in observation group were better than those in control group （ P 〉 0. 05,P 〉 0. 01） . After treatment,returning to normal times of cerebrospinal fluid indicators,clinical sings and symptoms were significantly shorter in observation group than those in control group （ P 〈 0. 01） . There was no significant difference in incidence rate of adverse reactions between the two groups （ P 〉 0. 05） . Conclusion Dexamethasone combined with Isoniazid by intrathecal injectionin treatment of patients with tuberculous meningitis may improve normal levels of cerebrospinal fluid and clinical symptoms more quickly with safety.

关 键 词：结核 脑膜 地塞米松 异烟肼 注射 脊髓 脑脊液常规 

分 类 号：R529.3[医药卫生—内科学]