鞘内注射两性霉素B治疗隐球菌性脑膜炎的临床观察

Clinical Observations on Intrathecal Administration of Amphotericin B in the Treatment of Cryptococcal Meningitis

目的观察鞘内注射两性霉素B(amphotericin B,AMB)治疗隐球菌性脑膜炎的疗效和不良反应。方法回顾性分析1995—2006年作者医院治疗的8例隐球菌性脑膜炎患者的临床资料,8例患者均采用同时鞘内注射和静脉注射AMB并联合应用氟康唑或氟胞嘧啶治疗。结果痊愈4例,好转3例,死亡1例;鞘内注射后均有头疼、恶心呕吐及下肢麻痛等症状,并出现短暂性双下肢截瘫2例,尿潴留1例,意识障碍2例。结论反复行腰穿放脑脊液控制颅压并联合鞘内注射AMB治疗隐球菌性脑膜炎疗效肯定,但患者有不同程度不良反应。

Objective To observe the efficacy and safety of intrathecal administration of amphotericin B （AMB） in the treatment of cryptococcal meningitis, Methods Eight patients with cryptococcal meningitis received intrathecal AMB therapy combined with intravenous AMB or fluconazole and flucytosine were retrospectively studied. All patients were performed repeat lumbar drainage for control of raised cerebrospinal fluid pressure. Results Of the eight patients received intrathecal AMB therapy, four were cured, three improved, and one died. Adverse reactions in the treatment were headache, nausea, vomiting, lower limbs pain, lower limbs paraplegia and disorder of consciousness. Conclusions The intrathecal AMB therapy may be a valuable approach in the treatment of cryptococcal meningitis but some degree of adverse reactions existed.