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目的观察鞘内注射氟康唑(FCZ)和两性霉素B(AMB)治疗隐球菌性脑膜炎的疗效和不良反应。方法回顾性分析1999年至2007年确诊的54例新型隐球菌脑膜炎住院患者的临床资料。全部病例均予AMB加5-氟胞嘧啶(5-FC)及FCZ治疗,采用诱导/巩固疗法。23例治疗4周后开始鞘内注射FCZ和/或AMB治疗,其余31例继续原方案治疗。结果鞘内注射治疗的23例患者治愈率78.3%,非鞘内注射的31例患者治愈率48.4%,两种治疗疗效差异有统计学意义(P<0.05)。鞘内注射组局部不良反应明显增加,表现为头痛、恶心、呕吐及短暂性双下肢麻痛感、截瘫、尿潴留等。结论联合鞘内注射FCZ和AMB治疗隐球菌性脑膜炎疗效肯定,但患者有不同程度不良反应。
Objective To observe the efficacy and adverse reactions of intrathecal fluconazole (FCZ) and amphotericin B (AMB) in the treatment of cryptococcal meningitis. Methods The clinical data of 54 patients with cryptococcal meningitis admitted in hospital from 1999 to 2007 were retrospectively analyzed. All cases were treated with AMB plus 5-fluorocytosine (5-FC) and FCZ with induction / consolidation therapy. Twenty-three patients started intrathecal FCZ and / or AMB treatment after 4 weeks of treatment, and the remaining 31 patients continued treatment. Results In the intrathecal injection, the cure rate of 23 patients was 78.3%. The non-intrathecal injection rate of 31 patients was 48.4%. The difference between the two treatments was statistically significant (P <0.05). Intrathecal injection of local adverse reactions increased significantly, manifested as headache, nausea, vomiting and transient lower extremity numbness, paraplegia, urinary retention and so on. Conclusion Combined intrathecal injection of FCZ and AMB treatment of cryptococcal meningitis is effective, but patients have different degrees of adverse reactions.