脑脊液持续引流置换联合鞘内注射两性霉素B治疗新型隐球菌性脑膜炎临床分析  

Clinical Analysis on Continuous Drainage of Cerebrospinal Fluid Replacement Combined with Intrathecal Injection of Amphotericin B in Treatment of Cryptococcus Meningitis

作　　者：何花 黄瑛 陈佳 徐俊 李文明 罗云 武彦 陈海云 王丽华 HE Hua;HUANG Ying;CHEN Jia;XU Jun;LI Wen-ming;LUO Yun;WU Yan;CHEN Hai-yun;WANG Li-hua(Dept. of Infectious Disease,The Third People's Hospital of Kunming City,Kunming Yunnan 650041,China)

机构地区：[1]昆明市第三人民医院感染二科,云南昆明650041

出　　处：《昆明医科大学学报》2019年第2期110-115,共6页Journal of Kunming Medical University

基　　金：昆明市卫生计生科研基金资助项目(2018-03-08-001)

摘　　要：目的探讨脑脊液持续引流置换,联合鞘内注射两性霉素B治疗新型隐球菌性脑膜炎疗效。方法选择新型隐球菌性脑膜炎患者23例,其中12例隐球菌性脑膜炎在静脉及口服抗真菌治疗基础上,联合腰大池脑脊液持续引流置换及鞘内注射两性霉素B治疗8周为治疗组;11例作为对照组,仅给予静脉及口服抗真菌治疗,阶段性对比治疗前后临床表现、脑压、脑脊液生化指标及病原检测、影像学等的变化。结果对照组和治疗组总有效率分别为54.4%、83.3%;治疗组高于对照组(P<0.05)。治疗组经治疗3 d后脑压即明显下降,通过对治疗3天及1、4、8周后脑压与治疗前比较差异均有统计学意义(P<0.05);治疗8周后脑脊液各项指标均恢复正常水平,其中脑脊液的蛋白、糖、细胞数与治疗前比较差异均有统计学意义(P<0.05)。鞘内注射两性霉素B平均剂量达(0.33±0.16) mg时无异常表现,超平均剂量后出现腰痛、双下肢麻木、排尿困难。结论鞘内注射合适的两性霉素B治疗隐球菌性脑膜炎安全、有效,能较快缓解颅内高压;脑脊液置换能减少脑脊液中病原体及其代谢产物、炎症因子等,净化脑脊液;鞘内注射两性霉素B,可提高颅内药物浓度,同时减少静脉给药剂量而降低药物毒副作用,能有效提高抗真菌疗效。。Objective To investigate the effect of continuous drainage of cerebrospinal fluid combined with intrathecal amphotericin B in the treatment of cryptococcal meningitis. Methods Twenty-three patients with cryptococcal meningitis were selected.among them,12 cases of cryptococcal meningitis were treated with intravenous and oral antifungal therapy,combined with continuous drainage of cerebrospinal fluid and intrathecal amphotericin B for 8 weeks. 11 cases were used as the control group,only intravenous and oral antifungal treatment, clinical manifestations,brain pressure,cerebrospinal fluid biochemical indicators and pathogen detection,imaging and other changes before and after the phase contrast treatment. Results The total effective rate of the control group and the treatment group were 54.4% and 83.3%,respectively. The treatment group was higher than the control group(P<0.05). After 3 days of treatment,the brain pressure of the treatment group decreased significantly. The brain pressure after treatment for 3 days,1,4,and 8 weeks was statistically significant(P<0.05). After 8 weeks of treatment,the cerebrospinal fluid indexes were all significant. The normal level was restored, and the protein,sugar and cell number of cerebrospinal fluid were significantly different from those before treatment(P<0.05). There was no abnormal performance when the average dose of intrathecal amphotericin B was(0.33±0.16)mg. After the ultra-average dose,low back pain,numbness of both lower extremities,and difficulty in urinating were observed. Conclusions Intrathecal injection of appropriate amphotericin B is safe and effective in the treatment of cryptococcal meningitis. It can relieve intracranial hypertension quickly. Cerebrospinal fluid replacement can reduce pathogens, their metabolites and inflammatory factors in cerebrospinal fluid,purify cerebrospinal fluid;intrathecal injection Amphotericin B can increase the concentration of intracranial drugs,reduce the dose of intravenous administration and reduce the side effects of drugs

关 键 词：新型隐球菌性脑膜炎 脑脊引流及置换 鞘内注射 两性霉素B 

分 类 号：R512[医药卫生—内科学]