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 fluid 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 fluid 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-inflammatory 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.
作者
焦云琦
杨扬
JIAO Yun-qi;YANG Yang(Zhumadian central hospital, one department of neurology, Zhumadian Henan 463000,China)
出处
《药品评价》
CAS
2019年第6期27-29,35,共4页
Drug Evaluation
关键词
CM
抗真菌药物
脑室-腹腔分流术
颅内压
隐球菌数
Cryptococcal Meningitis
Antifungal Drugs
Intraventricular Peritoneal Shunt
Intracranial Pressure
Cryptococcus Number
