腰大池持续引流联合鞘内注射治疗结核性脑膜炎的疗效及安全性观察

Efficacy and Safety of Continuous Lumbar Drainage Combined with Intrathecal Injection in the Treatment of Tuberculous Meningitis

目的探讨腰大池持续引流(CLD)并鞘内注射治疗结核性脑膜炎(TBM)的疗效与及安全性。方法回顾性分析我院2009年7月—2010年8月诊断TBM患者25例,其中15例采用CLD联合鞘内注射治疗(观察组),10例采用间断脑脊液置换联合鞘内注射治疗(对照组),综合临床症状、体征和脑脊液的转归情况对疗效进行评估。结果观察组15例患者中治愈10例,好转4例,无效1例;对照组10例患者中治愈4例,好转4例,无效2例,两组疗效间差异有统计学意义(P<0.05)。观察组无一例出现不良反应,对照组有3例患者出现不良反应,两组不良反应率间差异有统计意义(P<0.05)。观察组的平均住院日为(16.8±2.8)d,对照组的平均住院日为(21.2±4.2)d,差异有统计学意义(P<0.05)。结论 CLD联合鞘内注射治疗TBM安全、有效,能缩短平均住院日,患者依从性好。

Objective To investigate the effects and safety of continuous lumbar drainage（LD） combined with intrathecal injection in the treatment of tuberculous meningitis（TBM）.Methods A total of 25 patients with tuberculous meningitis treated by our hospital from July 2009 to August 2010 were retrospectively analyzed.Of them,15 were treated with lumbar drainage combined with intrathecal injection（the observation group）,and 10 were interruptedly treated with cerebrospinal fluid replacement combined with intrathecal injection（the control group）.Finally,we assessed the effects of the treatment using clinical symptoms,signs and outcomes of cerebrospinal fluid.Results Of the 15 cases in the treatment group,10 were cured,4 showed effectiveness and one showed no response;of the 10 cases in the control group,4 were cured,4 showed effectiveness,and two showed no response,with significant differences between the two groups（P0.05）.Incidence rate of adverse reactions were 0 in the observation group and 30%（3/10） in the control group（P0.05）.Average hospital stay were（16.8±2.8） days in the observation group and（21.2±4.2）days in the control group（P0.05）.Conclusion Continuous lumbar drainage combined with intrathecal is safe and effective in the treatment of tuberculous meningitis.It can shorten the average length of hospital stay and enhance the compliance of the patients.