本文選題：癌性腦膜炎 + 鞘內(nèi)輸注系統(tǒng)��； 參考：《福建醫(yī)科大學》2015年碩士論文

【摘要】：背景:癌性腦膜炎,作為腫瘤全身轉(zhuǎn)移最嚴重的并發(fā)癥,患者常死于進行性神經(jīng)病變,預(yù)后極差。目前以姑息治療為主,并無統(tǒng)一的治療方案。文獻報道一致認為早期診斷、早期治療可以最大化保存神經(jīng)功能,而且顯著提高生存質(zhì)量。因此,提高對本病的認識,并及早診斷治療將成為臨床工作的一大研究課題。目的:癌性腦膜炎目前尚無有效治療方案,以姑息治療為主,包括全腦放射治療,鞘內(nèi)化療,全身化療等,但療效差。癌性腦膜炎主要引起顱內(nèi)高壓破壞神經(jīng)功能,治療原則是盡可能地改善或者穩(wěn)定神經(jīng)功能,延長生存期,提高生活質(zhì)量。通過觀察鞘內(nèi)輸注系統(tǒng)持續(xù)引流腦脊液對癌性腦膜炎伴顱內(nèi)壓升高患者的臨床療效,為癌性腦膜炎的治療提供臨床參考。方法:1.病例收集病例來源于南京軍區(qū)福州總醫(yī)院第四七六臨床部腫瘤科于2013年3月1日至2014年12月31日收治的并且應(yīng)用鞘內(nèi)輸注系統(tǒng)引流腦脊液的16例癌性腦膜炎伴有顱內(nèi)壓升高患者。16例患者中,男性7例(43.75%),女性9例(56.25%);年齡39-70歲,平均年齡53.1歲。16例患者全部明確腫瘤病史,有相應(yīng)的臨床以及影像學表現(xiàn),并經(jīng)過腦脊液細胞學檢查確診。2.治療方法16例患者因病情因素及機體原因未能進一步行�？浦委�,均行最佳支持治療(BSC)。術(shù)前給予地塞米松、甘油果糖、甘露醇等脫水劑進行脫水降顱壓保守治療,效果并不理想。完善術(shù)前準備后,行鞘內(nèi)輸注系統(tǒng)植入術(shù)持續(xù)引流腦脊液,緩解顱內(nèi)壓升高癥狀。3.評價一周后評價患者臨床療效評估,卡氏評分及生活質(zhì)量評估,心理狀態(tài)評估,并統(tǒng)計患者的生存時間。4.統(tǒng)計學方法所得數(shù)據(jù)均采用SPSS17.0軟件進行統(tǒng)計。采用雙側(cè)檢驗的假設(shè)檢驗,P≤0.05被認為所檢驗的差異有統(tǒng)計學意義�？尚艆^(qū)間采用95%的可信度。采用Wilcoxon秩和檢驗分析患者的KPS評分平均值改變及QOL、SAS評分。用Kaplan-Meier方法繪制生存函數(shù)。結(jié)果:1.16例患者中,1例失訪,隨訪率達到93.75%。其中1例患者死于腦卒中。行卡氏評分,術(shù)后患者均有不同程度的升高且維持一段時間。之后隨病情惡化逐步降低。手術(shù)后患者的臨床癥狀,如頭痛、惡心、嘔吐,意識障礙等顯著改善,術(shù)后隨訪1周患者的K氏評分比術(shù)前顯著提高,并且可維持一段時間。生活質(zhì)量評分以及心理狀態(tài)明顯改善。2.從患者診斷癌性腦膜炎開始計算生存期,完成治療后,后續(xù)隨訪生存48周的1例(6.25%),24-48周的0例(0%),12-24周的2例(12.50%),4-12周的6例(37.50%),4周的6例(37.50%)�；颊咧形簧嫫�8.30周(95%CI,2.11-14.49)。與目前文獻資料報道的中位生存期4-6周相比,能延長患者生存期。結(jié)論:1.鞘內(nèi)輸注系統(tǒng)能夠緩解顱內(nèi)壓升高,顯著改善患者的臨床癥狀,提高患者的生存質(zhì)量。2.患者生存期延長,但樣本數(shù)較少,需進一步證實。
[Abstract]:Background: carcinomatous meningitis, as the most serious complication of tumor metastasis, often dies of progressive neuropathy and its prognosis is very poor. At present, palliative treatment is the main treatment, and there is no unified treatment plan. Literature reports agree that early diagnosis and treatment can maximize the preservation of neural function and significantly improve the quality of life. Therefore, improving the understanding of the disease and early diagnosis and treatment will become a major research topic in clinical work. Objective: there is no effective treatment for carcinomatous meningitis. Palliative therapy is the main treatment, including whole brain radiotherapy, intrathecal chemotherapy, systemic chemotherapy and so on, but the curative effect is poor. The treatment principle is to improve or stabilize the nerve function as far as possible, prolong the survival period and improve the quality of life. To observe the clinical effect of continuous drainage of cerebrospinal fluid (CSF) by intrathecal infusion system in patients with carcinomatous meningitis associated with elevated intracranial pressure, and to provide clinical reference for the treatment of carcinomatous meningitis. Method 1: 1. Cases were collected from 16 cases of carcinomatous meningitis associated with cerebrospinal fluid drainage using intrathecal infusion system from March 1, 2013 to December 31, 2014, Department of Oncology, Clinical Department No. 476, Fuzhou General Hospital of Nanjing military region. Of the 16 patients with elevated intracranial pressure, The age was 39-70 years old, the average age was 53.1 years old. All the 16 patients had definite tumor history, had corresponding clinical and imaging manifestations, and were diagnosed by cerebrospinal fluid cytology. Methods 16 patients were treated with the best support therapy because of the disease condition and the organism reason. Preoperative dehydration and intracranial pressure reduction with dexamethasone, fructose and mannitol were not satisfactory. After the preoperative preparation was improved, continuous drainage of cerebrospinal fluid was performed with intrathecal infusion system to relieve the symptoms of intracranial pressure elevation. A week later, the patients were evaluated for their clinical efficacy, Karnoff score and quality of life assessment, psychological status assessment, and survival time of the patients. 4. 4. SPSS 17.0 software was used to analyze the data obtained by statistical methods. Using the hypothesis test of bilateral test P 鈮，

本文編號：2032093