改良腰大池置管术及不同椎管给药次数治疗结核性

Clinical efficacy observation of tuberculous meningitis patients with improved lumbar cistern catheter drainage and drug injection

将2009年3月至2015年12月内蒙古自治区呼伦贝尔市传染病院收治的60例结核性脑膜炎患者采用随机数字表法分为两组，每组各30例，均给予抗结核药物及糖皮质激素治疗。其中一组采用常规腰椎穿刺，椎管给药及脑脊液置换每周2～3次（简称“对照组”）；另一组利用硬膜外联合麻醉包及麻醉置管技术将导管置入腰大池，改椎管给药及脑脊液置换次数为2次／d（简称“改良组”）。比较两组患者治疗17d和出院时各项脑脊液指标和颅内压的变化及恢复时间、临床转归，症状缓解情况及平均总住院天数。经过17d治疗后，改良组脑脊液蛋白及颅内压恢复情况明显优于对照组（[（1．62±0．95）、（2．53±1．25）]和[（212．33±54．37）、（254．26±62．96）]），差异具有统计学意义（t值分别为3．102、2．697，P值均〈0．01），且脑脊液蛋白及颅内压恢复正常时间明显低于对照组（[（41．83±10．04）d和（53．07±5．14）d]和[（15．63±2．74）d和（26．48±3．38）d]），差异具有统计学意义（t值分别为5．398、13．232，P值均〈0．01）。改良组平均总住院天数[（43．20±22．87）d]明显短于对照组[（59．57±30．73）d]，差异具有统计学意义（t=7．771，P=0．039）；改良组总体好转率（96．7％，29／30）明显高于对照组（66．7％，20／30），差异有统计学意义（χ2=15．843．P〈0．01）；采用改良腰椎置管术，通过改变椎管给药及脑脊液置换次数治疗结核性脑膜炎具有良好的临床应用价值。

Sixty patients with tuberculous meningitis （TBM） admitted and given antituberculosis drugs and glucocorticoid in Hulunbeier Tuberculosis Hospital were randomly divided into two groups according to the random number table （30 cases each group）, during Mar. 2009 to Dec. 2015. Patients in one group were treated with rou tine lumbar puncture, spinal administration and cerebrospinal fluid replacement 2 to 3 times every week （control group and patients in another group with improved lumbar cistern catheter drainage and drug injection and cerebro- spinal fluid （CSF） replacement 2 times daily （improvement group）. The data including CSF index, change and re- covery time of intracranial pressure, clinical outcome, clinical symptom relief and average total hospitalization days were compared between two groups of patients in the 17th day and discharge. The total amount of CSF proteins and intracranial pressure in improvement group were significantly better than those in the control group in the 17th days. （（1.62±0.95） vs. （2.53±1.25）） and （（212.33±54.37） vs. （254.26±62.96））（t： 3.102,2.697,P〈0.01）. The recovery time of protein of CSF and intracranial pressure in improvement group were significantly lower than those in the control group in the 17th days （（41.83±10.04） d vs. 53.07±5.14） d） and （（15.63±2.74） d vs. （26.48 ± 3.38） d） （t ： 5. 398,13. 232, P〈 0.01 ）. The average total hospitalization days in improvement group was significantly shorter than that in the control group （ （43.20 ± 22.87 ） d vs. （59.57 ±30.73） d） （t = 7. 771, P = 0. 039）. The total improvement rate in the improvement group was significant higher than that in the control group （（96.7% ,29/30） vs （66.7% ,20/30）） （χ2 =15. 843, P〈0.01）. We conclude that improved lumbar cistern catheter drainage and drug injection and CSF replacement have a good clinical value for treatment of TBM.