V-P分流治疗伴恶性颅高压新型隐球菌性脑膜炎临床分析

Effects on the early V-P shunting treating patients with malignant hypertension cranial cryptococcus neoformans meningitis

目的观察早期V-P分流术治疗伴有恶性颅高压的新型隐球菌性脑膜炎患者的临床效果。方法对11例伴有恶性颅高压的新型隐球菌性脑膜炎患者采用V-P分流术,同时给予两性霉素-B静脉、鞘内注射及5-氟胞嘧啶口服等常规治疗,以隐球菌计数阴性及临床症状改善情况为观察指标。结果有头痛、呕吐、意识障碍的患者经V-P分流术后症状快速减轻,所有患者精神状态短期内明显好转;甘露醇、甘油果糖脱水剂可明显减量。1例视力障碍的患者经引流处理2d后视力基本正常,仅有1例遗留有轻度视力障碍。经联合治疗最后痊愈9例,好转2例。10例患者随访至今均无复发。结论早期V-P分流术能有效降低新型隐球菌性脑膜炎颅内压,改善临床症状,为抗真菌治疗赢取时间,优于侧脑室外引流、腰大池置管持续外引流或留置Ommaya者。随访无复发。

Objective To observe the clinical effects of the early V- P shunting treating patients with malignant hypertension cranial cryptococcus neoformans meningitis. Methods Eleven patients with malignant hypertension cranial cryptoeoceus neoformans meningitis were treated by V P shunting, meanwhile using conventional treatment such as injecting or scabharing amphoteriein B vein, as well as oraling 5-fiucytoslne. The observing indexes were that cryptococcus counting negative and clinical symptoms improve ment. Results The symptoms of all patients who had headache, vomiting, consciousness obstacle relieve in short-term after V-P shunting, so mannitol, glycerin fructose agent can obviously reduced. One patient with a eyesight obstacle became basically normal after 2 days by V- P shunting, and only one left a mild visual impairment. The combination therapy finally healed 9 eases ,improved 2 eases and all of patients had no recurrence. Conclusion V-P shuntting can effectively reduce the cryptococcus neoformans meningitis intracranial pressure, improve the clinical symptoms, save time for antifungal therapy. V - P shuntting is more superior than the lateral ventricle or waist big pool external drainage.