不同腦脊液引流方式對AIDS合并新型隱球菌腦膜炎患者顱高壓預(yù)后影響
發(fā)布時間：2018-10-22 17:46
【摘要】：目的探討艾滋病(AIDS)合并新型隱球菌腦膜炎伴顱內(nèi)高壓的治療策略,以降低其病死率。方法對AIDS合并新型隱球菌腦膜炎伴顱高壓癥狀的患者,在抗真菌治療的基礎(chǔ)上,分別采用反復(fù)腰椎穿刺、腰大池置管引流、ommaya囊引流、腦室腹腔分流,根據(jù)初始顱內(nèi)壓的水平比較不同腦脊液引流方式的治療效果。結(jié)果共計調(diào)查AIDS合并新型隱球菌腦膜炎并顱內(nèi)高壓患者34例。顱內(nèi)壓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。單純采用反復(fù)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;采用內(nèi)引流的3例患者均痊愈。結(jié)論對于AIDS合并新型隱球菌腦膜炎伴顱內(nèi)高壓的患者,可根據(jù)初始顱內(nèi)壓水平采用不同的降顱內(nèi)高壓的策略。在充分抗真菌治療的基礎(chǔ)上,對合并惡性顱內(nèi)高壓的患者,建議盡早行腰大池、ommaya囊引流、腦室腹腔分流,以有效控制顱內(nèi)高壓,提高臨床療效,降低病死率。
[Abstract]:Objective to explore the treatment strategy of (AIDS) combined with Cryptococcus neoformans meningococcal meningitis with intracranial hypertension in order to reduce the mortality. Methods the patients with AIDS complicated with Cryptococcus neoformans meningitis accompanied with cranial hypertension were treated with repeated lumbar puncture, lumbar cistern drainage, ommaya capsule drainage and intraventricular and abdominal shunt respectively on the basis of antifungal therapy. The therapeutic effects of different cerebrospinal fluid drainage methods were compared according to the level of initial intracranial pressure. Results A total of 34 patients with AIDS complicated with cryptococcal meningitis and intracranial hypertension were investigated. Of the 9 patients with 250~350mmH2O, 8 recovered and 1 died, and of the 19 350mmH2O patients, 13 recovered and 6 died. Of the 27 patients with recurrent lumbar puncture, 22 were cured and 5 died, 2 were cured and 2 died of external drainage, and 3 were cured by internal drainage. Conclusion for patients with AIDS complicated with Cryptococcus neoformans meningitis with intracranial hypertension, different strategies of lowering intracranial hypertension can be adopted according to the level of initial intracranial pressure. On the basis of adequate antifungal therapy, it is suggested that the patients with malignant intracranial hypertension should be treated with lumbar cistern, ommaya sac drainage and intraventricular and peritoneal shunt as early as possible in order to effectively control intracranial hypertension, improve clinical efficacy and reduce mortality.
【作者單位】： 杭州市西溪醫(yī)院感染二科;
【基金】：杭州市科技局項目(20170533B81)~~
【分類號】：R519.4
本文編號：2287872
[Abstract]:Objective to explore the treatment strategy of (AIDS) combined with Cryptococcus neoformans meningococcal meningitis with intracranial hypertension in order to reduce the mortality. Methods the patients with AIDS complicated with Cryptococcus neoformans meningitis accompanied with cranial hypertension were treated with repeated lumbar puncture, lumbar cistern drainage, ommaya capsule drainage and intraventricular and abdominal shunt respectively on the basis of antifungal therapy. The therapeutic effects of different cerebrospinal fluid drainage methods were compared according to the level of initial intracranial pressure. Results A total of 34 patients with AIDS complicated with cryptococcal meningitis and intracranial hypertension were investigated. Of the 9 patients with 250~350mmH2O, 8 recovered and 1 died, and of the 19 350mmH2O patients, 13 recovered and 6 died. Of the 27 patients with recurrent lumbar puncture, 22 were cured and 5 died, 2 were cured and 2 died of external drainage, and 3 were cured by internal drainage. Conclusion for patients with AIDS complicated with Cryptococcus neoformans meningitis with intracranial hypertension, different strategies of lowering intracranial hypertension can be adopted according to the level of initial intracranial pressure. On the basis of adequate antifungal therapy, it is suggested that the patients with malignant intracranial hypertension should be treated with lumbar cistern, ommaya sac drainage and intraventricular and peritoneal shunt as early as possible in order to effectively control intracranial hypertension, improve clinical efficacy and reduce mortality.
【作者單位】： 杭州市西溪醫(yī)院感染二科;
【基金】：杭州市科技局項目(20170533B81)~~
【分類號】：R519.4
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1 ;獲得性免疫缺陷綜合癥(aids艾滋癥)[J];國外科技資料目錄.醫(yī)藥衛(wèi)生;1997年02期
2 李建緒,張雪玲;AIDs及其治療藥物[J];臨床薈萃;2000年13期
3 王忠民;;低維生素A的AIDs患者肝蛋白合成減少[J];傳染病信息;1996年02期
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