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目的探讨艾滋病(AIDS)合并新型隐球菌脑膜炎伴颅内高压的治疗策略,以降低其病死率。方法对AIDS合并新型隐球菌脑膜炎伴颅高压症状的患者,在抗真菌治疗的基础上,分别采用反复腰椎穿刺、腰大池置管引流、ommaya囊引流、脑室腹腔分流,根据初始颅内压的水平比较不同脑脊液引流方式的治疗效果。结果共计调查AIDS合并新型隐球菌脑膜炎并颅内高压患者34例。颅内压200~249mmH2O的6例患者均痊愈;250~350mmH2O的9例患者中,8例痊愈,1例死亡;>350mmH2O的19例患者中,13例痊愈,6例死亡。单纯采用反复腰椎穿刺的27例患者中,22例痊愈,5例死亡;采用外引流的4例患者中,2例痊愈,2例死亡;采用内引流的3例患者均痊愈。结论对于AIDS合并新型隐球菌脑膜炎伴颅内高压的患者,可根据初始颅内压水平采用不同的降颅内高压的策略。在充分抗真菌治疗的基础上,对合并恶性颅内高压的患者,建议尽早行腰大池、ommaya囊引流、脑室腹腔分流,以有效控制颅内高压,提高临床疗效,降低病死率。
Objective To explore the treatment strategy of AIDS combined with Cryptococcus neoformans meningitis and intracranial hypertension to reduce its mortality. Methods On the basis of antifungal therapy, the patients with AIDS complicated with cryptococcal meningitis and intracranial hypertension were treated with repeated lumbar puncture, lumbar cistern catheterization, ommaya balloon drainage, ventricle peritoneal shunt, and initial intracranial pressure Different levels of cerebrospinal fluid drainage methods of treatment. Results A total of 34 AIDS patients with cryptococcal meningitis and intracranial hypertension were investigated. Among 9 patients with 250 ~ 350 mmH2O, 8 recovered and 1 died. Of the 19 patients with> 350 mmH2O, 13 recovered and 6 died. Of the 27 patients who underwent repeated lumbar puncture alone, 22 recovered and 5 died. Of the 4 patients who received external drainage, 2 recovered and 2 died. All 3 patients undergoing internal drainage were cured. Conclusions For patients with cryptococcal meningitis complicated with intracranial hypertension, different strategies of decreasing intracranial pressure may be used depending on the initial intracranial pressure. On the basis of full antifungal therapy, it is suggested that patients with malignant intracranial hypertension should go to the lumbar labyrinth as soon as possible, ommaya drainage, and intraperitoneal shunt to effectively control intracranial hypertension and improve clinical efficacy and mortality.