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目的比较鞘内注射与静脉滴注给药治疗结核性脑膜炎的临床疗效。方法选取2012年三峡大学仁和医院收治的结核性脑膜炎患者82例,采用随机数字表法分为对照组和观察组,各41例,两组患者均给予2HRZE/4HR抗结核治疗方案,对照组患者采用异烟肼和地塞米松静脉滴注,观察组患者采用异烟肼和地塞米松鞘内注射。比较两组患者临床疗效、不良反应情况、临床疗效指标及治疗前后脑脊液常规指标、生化指标。结果观察组患者临床疗效优于对照组(u=3.276,P=0.001)。两组患者消化道出血及血脂、血糖、电解质异常发生率比较,差异均无统计学意义(P>0.05)。两组患者治疗前脑脊液细胞数、蛋白质、葡萄糖及氯化物含量比较,差异均无统计学意义(P>0.05);观察组患者治疗后脑脊液细胞数、氯化物含量高于对照组,蛋白质、葡萄糖含量低于对照组(P<0.05)。观察组患者头痛颈强消失时间、脑脊液压力恢复正常时间、脑脊液细胞恢复正常时间、脑脊液蛋白恢复正常时间、发热时间、昏迷时间及住院时间均短于对照组(P<0.05)。结论在2HRZE/4HR治疗方案基础上采用异烟肼和地塞米松鞘内注射给药治疗结核性脑膜炎的临床疗效优于静脉滴注,可有效缓解患者临床症状、降低颅内压、改善脑脊液循环。
Objective To compare the clinical effects of intrathecal injection and intravenous drip in the treatment of tuberculous meningitis. Methods Eighty-two patients with tuberculous meningitis admitted to Renhe Hospital of the Three Gorges University in 2012 were divided into control group and observation group by random number table, and 41 patients in each group were given anti-tuberculosis treatment program of 2HRZE / 4HR. The control group Patients were treated with intravenous drip of isoniazid and dexamethasone, and patients in the observation group received intrathecal injection of isoniazid and dexamethasone. Clinical efficacy, adverse reactions, clinical curative effect and cerebrospinal fluid routine and biochemical indexes before and after treatment were compared between the two groups. Results The clinical efficacy of the observation group was better than that of the control group (u = 3.276, P = 0.001). There was no significant difference in incidence of gastrointestinal bleeding, blood lipid, blood glucose and electrolyte between the two groups (P> 0.05). There was no significant difference in the contents of cerebrospinal fluid, protein, glucose and chloride between the two groups before treatment (P> 0.05). The cerebrospinal fluid cell number and chloride content in the observation group were higher than those in the control group, protein, glucose Content was lower than the control group (P <0.05). The duration of disappearance of headache and neck strength, normal time of cerebrospinal fluid pressure, normal time of cerebrospinal fluid recovery, normal time of cerebrospinal fluid recovery, fever, coma and hospital stay in observation group were shorter than those in control group (P <0.05). Conclusion The clinical efficacy of intrathecal administration of isoniazid and dexamethasone for tuberculous meningitis is superior to that of intravenous infusion on the basis of 2HRZE / 4HR treatment, which can effectively relieve clinical symptoms, reduce intracranial pressure and improve cerebrospinal fluid cycle.