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目的探讨腰大池和脑室外引流术对获得性免疫缺陷综合征(亦称艾滋病)合并隐球菌性脑膜炎患者颅内高压的治疗效果。方法共138例隐球菌性脑膜炎合并颅内高压患者[人类免疫缺陷病毒(HIV)阳性36例、HIV阴性102例],抗隐球菌治疗的同时,76例行腰大池引流术、改良腰大池引流术或脑室外引流术(HIV阳性17例、HIV阴性59例),62例行腰椎穿刺鞘内给药(HIV阳性19例、HIV阴性43例),比较引流组与鞘内给药组以及两组HIV阳性亚组与HIV阴性亚组患者引流管留置时间、脑脊液隐球菌培养转阴时间、并发症情况,并进行疗效评价。结果引流组患者治疗1周内颅内高压症状即明显改善。首次引流管置管中位时间30(17,35)d,其中HIV阳性者与HIV阴性者差异无统计学意义[28(15,32)d对30(18,35)d;U=-1.459,P=0.144]。引流组脑脊液隐球菌培养转阴中位时间41(26,58)d,其中HIV阳性者与HIV阴性者差异无统计学意义[46(28,66)d对36(21,45)d;U=-1.608,P=0.108];鞘内给药组脑脊液隐球菌培养转阴中位时间42(32,65)d,其中HIV阳性者与HIV阴性者差异无统计学意义[52(38,68)d对39(30,62)d;U=-0.401,P=0.688];而引流组与鞘内给药组差异有统计学意义(U=-2.117,P=0.034)。引流组治疗总有效率为86.84%(66/76),其中HIV阳性者与HIV阴性者差异无统计学意义[14/17对89.83%(53/59);χ~2=0.172,P=0.678];鞘内给药组为72.58%(45/62),其中HIV阳性者与HIV阴性者差异无统计学意义[8/19对86.05%(37/43);χ~2=0.023,P=0.880];而引流组与鞘内给药组差异有统计学意义(χ~2=4.413,P=0.036)。结论早期采用腰大池或脑室外引流术治疗艾滋病合并隐球菌性脑膜炎患者能够有效控制颅内高压、缩短有症状病程、提高临床疗效。
Objective To investigate the therapeutic effect of lumbar cistern and intraventricular drainage on patients with acquired immunodeficiency syndrome (also known as AIDS) complicated with intracranial hypertension in patients with cryptococcal meningitis. Methods A total of 138 patients with cryptococcal meningitis complicated with intracranial hypertension (36 HIV-positive and 102 HIV-negative) were treated with anti-cryptococcosis. Meanwhile, 76 patients underwent lumbar drainage and modified lumbar cistern (17 cases of HIV positive and 59 cases of HIV negative), 62 cases of intrathecal administration of lumbar puncture (19 cases of HIV positive and 43 cases of HIV negative), drainage group and intrathecal group Two groups of HIV-positive subgroup and HIV-negative subgroup of patients with drainage tube indwelling time, CSF cryptococcal culture negative time, complications, and efficacy evaluation. Results Patients with drainage group within 1 week of treatment of intracranial hypertension symptoms significantly improved. The median time of the first drainage tube was 30 (17, 35) d, and there was no significant difference between HIV positive and HIV negative patients (28 (15,32) d vs 30 (18,35) d; U = -1.459 , P = 0.144]. In the drainage group, the median time to negative conversion of Cryptococcus neoformans was 41 (26,58) d, and there was no significant difference between HIV-positive and HIV-negative patients (46 (28,66) d vs 36 (21,45) d; U = -1.608, P = 0.108]. In the intrathecal group, the median time to negative conversion of Cryptococcus neoformans was 42 (32,65) days, with no significant difference between HIV-positive and HIV-negative patients [52 ) d vs 39 (30,62) d; U = -0.401, P = 0.688]. The difference between the drainage group and the intrathecal administration group was statistically significant (U = -2.117, P = 0.034). The total effective rate was 86.84% (66/76) in the drainage group, and there was no significant difference between HIV positive and HIV-negative patients (14/17 vs. 89.83%, 53/59, χ ~ 2 = 0.172, P = 0.678 ] In the intrathecal group and 72.58% (45/62) in the intrathecal group. There was no significant difference between HIV-positive and HIV-negative patients (8/19 vs 86.05% (37/43), χ ~ 2 = 0.023, P = 0.880]. The difference between the drainage group and the intrathecal administration group was statistically significant (χ ~ 2 = 4.413, P = 0.036). Conclusion The early use of lumbar cistern or ventricular drainage in the treatment of AIDS patients with cryptococcal meningitis can effectively control intracranial hypertension, shorten the duration of symptoms and improve clinical efficacy.