鞘内注射异烟肼联合地塞米松治疗结核性脊膜脊髓炎的价值

The Value of Isoniazid Intrathecal Injection Combined with Dexametha sone for Treatment of Tuberculous Meningo Myelitis

目的:探讨鞘内注射异烟肼联合地塞米松治疗结核性脊膜脊髓炎的临床价值。方法:选择结核性脊膜脊髓炎患者80例,分为两组,各40例,对照组实施异烟肼1200mg/d、链霉素600mg/d、利福平1g/d肌内注射,地塞米松10mg/d静脉注射,观察组则将异烟肼与地塞米松改为鞘内注射,连续治疗8周为1疗程,对所有患者随访20周,比较治疗前后两组脑脊液常规与生化结果,统计两组脑脊液细胞、蛋白、氯化物及糖恢复正常时间及治疗期间发生的不良反应。结果:治疗后两组,脊液中糖、蛋白、氯化物水平及细胞总数均显著低于治疗前(P<0.05),观察组脊液中糖、蛋白、氯化物水平及细胞总数均低于对照组(P<0.05),观察组脑脊液细胞、蛋白、氯化物及糖恢复正常时间均显著快于对照组(P<0.05),观察组发生腰疼、背痛,低颅压性头痛及肝功能损伤的比例显著低于对照组(P<0.05)。结论:鞘内给予异烟肼联合地塞米松能有效提高脑脊液内药物浓度,提高药物治疗效果,缩短化疗时间,减少全身用药的不良反应。

Objective： To investigate the clinical value of intrathecal injection of isoniazid combinaed with dexamethasone for tuberculous meningo myelitis. Method： 80 cases with tuberculous meningomyelitis were divided into two groups： observation group and control group,with 40 cases in each group. The patients in control group received intramuscular injection of isoniazid 1200 mg / d,streptomycin 600 mg / d,and rifampicin 1g / d as well as intravenous injection of betamethasone 10 mg / d. The patients in observation group received intrathecal injection of isoniazid and dexamethasone. The two groups were treated continuously for 8 weeks,and all patients were followed up for 20 weeks. Then,the routine examination of cerebrospinal fluid before and after treatment in the two groups. The data wre collected and recorded about the recovery time of cerebrospinal fluid cell,protein,chloride and glucose as well as abverse reactions during treatment. Result： After treatment,the sugar,protein,chloride levels and total cell number in spinal fluid were significantly lower than before in the two groups（ P〈0. 05）. These indicators in the observation group were lower than those in the control group（ P〈0. 05）. The recovery times of cells,protein,chloride and sugar in cerebrospinal fluid in observation group were faster than those in control group（ P〈0. 05）. The proportions of lumbago,back pain,low intracranial pressure headache and liver function injury were much lower than those in control group（ P〈0.05）. Conclusion： Intrathecal isoniazid and dexamethasone can effectively improve drug concentration in cerebrospinal fluid and the efficacy of drug treatment,shorten the chemotherapy time and reduce the adverse reactions of systemic administration.