抗真菌药物联合脑室-腹腔分流术治疗新型隐球菌性脑膜炎的临床研究
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摘要
目的:观察新型隐球菌性脑膜炎(Cryptococcal meningitis,CM)应用抗真菌药物与脑室-腹腔分流术联合治疗的效果。方法:选取2016年1月—2018年5月我院收治的24例CM患者,均接受抗真菌药物治疗与脑室-腹腔分流手术。比较治疗前后颅内压水平、脑脊液隐球菌数目,并对症状改善、疗效、术后感染与引流管状况进行记录。结果:治疗后患者颅内压低于治疗前,脑脊液隐球菌数少于治疗前,差异有统计学意义(P<0.05);经治疗,24例CM患者中的23例治疗后呕吐、头痛等症状得到缓解;10例意识障碍患者,9例治疗后神志转清,1例因脑疝致死;5例视力障碍患者治疗后视力基本恢复,仅1例存在轻度视力障碍;2例合并外展受限患者治疗后外展恢复正常;治疗总有效率为95.83%;术后感染程度轻,予以抗炎治疗后即可缓解,未发生隐球菌感染扩散以及引流管堵塞等问题。结论:针对CM患者,在抗真菌药物治疗的基础上,行脑室-腹腔分流术可有效降低颅内压,减少隐球菌数,且安全性较高,利于患者恢复健康。
Objective: To observe the effect of antifungal drugs combined with ventricular-peritoneal shunt in the treatment of Cryptococcus neoformans meningitis(Cryptococcal meningitis, CM). Methods: From January 2016 to May 2018, 24 patients with CM were treated with antifungal drugs and intraventricular peritoneal shunt. The levels of intracranial pressure and the number of Cryptococcus in cerebrospinal ?uid were compared before and after treatment, and the improvement of symptoms, curative effect, postoperative infection and drainage tube status were recorded. Results:After treatment, the intracranial pressure was lower and the number of Cryptococcus in cerebrospinal ?uid was lower than that before treatment. In 24 patients with CM, the symptoms such as vomiting and headache were alleviated after treatment, 9 patients with consciousness disorder and 1 patient died of cerebral hernia after treatment, and the symptoms of vomiting and headache were relieved after treatment in 10 patients with consciousness disorder(P<0.05). The visual acuity of 5 patients with visual impairment was basically recovered, only 1 patient had mild visual impairment, 2 patients with limited abduction had normal recovery after treatment, the total effective value of treatment was 95.83%. The degree of infection was light after operation, which could be alleviated after anti-in?ammatory treatment, and no problems such as the spread of Cryptococcus infection and blockage of drainage tube were found. Conclusion: For patients with CM, on the basis of treatment with antifungal drugs, intraventricular-peritoneal shunt can effectively reduce intracranial pressure, reduce the number of Cryptococcus, and high safety, conducive to the patient's health recovery.
Objective: To observe the effect of antifungal drugs combined with ventricular-peritoneal shunt in the treatment of Cryptococcus neoformans meningitis(Cryptococcal meningitis, CM). Methods: From January 2016 to May 2018, 24 patients with CM were treated with antifungal drugs and intraventricular peritoneal shunt. The levels of intracranial pressure and the number of Cryptococcus in cerebrospinal ?uid were compared before and after treatment, and the improvement of symptoms, curative effect, postoperative infection and drainage tube status were recorded. Results:After treatment, the intracranial pressure was lower and the number of Cryptococcus in cerebrospinal ?uid was lower than that before treatment. In 24 patients with CM, the symptoms such as vomiting and headache were alleviated after treatment, 9 patients with consciousness disorder and 1 patient died of cerebral hernia after treatment, and the symptoms of vomiting and headache were relieved after treatment in 10 patients with consciousness disorder(P<0.05). The visual acuity of 5 patients with visual impairment was basically recovered, only 1 patient had mild visual impairment, 2 patients with limited abduction had normal recovery after treatment, the total effective value of treatment was 95.83%. The degree of infection was light after operation, which could be alleviated after anti-in?ammatory treatment, and no problems such as the spread of Cryptococcus infection and blockage of drainage tube were found. Conclusion: For patients with CM, on the basis of treatment with antifungal drugs, intraventricular-peritoneal shunt can effectively reduce intracranial pressure, reduce the number of Cryptococcus, and high safety, conducive to the patient's health recovery.
引文
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[2]张齐龙,况卫丰,刘子林,等.腰大池和脑室外引流术在艾滋病合并隐球菌性脑膜炎患者颅内高压治疗中的应用[J].中国现代神经疾病杂志,2016,16(8):492-496.
[3]王兵,廖勇仕,罗伦,等.脑室腹腔分流术在新型隐球菌脑膜炎中的应用[J].国际神经病学神经外科学杂志,2017,44(3):229-232.
[4]李晓杰,王庆亮,周文营,等.新型隐球菌颅内感染的临床特征及治疗转归[J].中华医院感染学杂志,2018,28(17):2564-2566.
[5]吴江,贾建平,崔丽英.神经病学[M].北京:人民卫生出版社,2005:204-207.
[6]宋旸,矫黎东,王宪玲,等.新型隐球菌脑膜炎24例临床分析[J].北京医学,2017,39(5):464-467.
[7]卢苏梅,李聪,冯宪真,等.氟胞嘧啶两性霉素B脂质体伊曲康唑联合治疗隐球菌性脑膜炎80例临床分析[J].中国实用神经疾病杂志,2016,19(15):72-73.
[8]陈静丹,盛吉芳.隐球菌性脑膜炎的诊断与治疗[J].中国微生态学杂志,2018,30(3):344-349.
[9]张英,朱建芸,林国莉,等.抗真菌药物联合脑室-腹腔分流术治疗新型隐球菌性脑膜炎[J].中山大学学报(医学科学版),2016,37(4):575-578.
[10]蒙有石,吴原,唐友莲,等.新型隐球菌性脑膜炎21例临床分析[J].广西医科大学学报,2016,33(2):327-329.
[11]赵杰,刘景平,张治平,等.分流手术治疗新型隐球菌性脑膜炎的体会与文献回顾[J].中南大学学报(医学版),2016,41(5):541-547.
[12]刘星靓,邓湘红,汤海亮,等.新型隐球菌性脑膜炎25例临床分析[J].中国临床医生杂志,2016,44(9):54-56.