脑室腹腔分流术治疗重症结核性脑膜炎合并脑积水的临床疗效研究

Theclinical Effect of Ventriculoperitoneal Shunt in the Treatment of Severe Tuberculous Meningitis Complicated with Hydrocephalus

目的分析重症结核性脑膜炎合并脑积水患者应用脑室腹腔分流术治疗的临床疗效.方法选取 2 0 1 5年 1 2 月- 2017年 04 月在本院收治的重症结核性脑膜炎合并脑积水患者 1 6 例,所有患者均给予脑室腹腔分流术进行治疗.观察并比 较患者治疗前后的脑脊液参数、脑室体部宽度指数以及颅压.结果 治疗后患者的脑室体部宽度指数（ 2. 83±0. 18）、氯化物 （116. 90±2. 23）mmol/L较治疗前脑室体部宽度指数（ 2. 12±0 . 12 ）、氯化物（ 93. 52±3. 40）mmol/L明显升高,其腺苷脱氢 酶（ 4. 16±0. 12）U/L、脑脊液蛋白（ 0. 45±0. 09）g/L、白细胞数（ 17. 40±2. 60）× 106/L 以及颅压（ 82. 2 2± 11. 72）mmH20 较 治疗前腺苷脱氢酶（ 10. 81 ± 1. 10） U/L、脑脊液蛋白（ 2. 21 ± 0. 50） g/L、白 细胞数（ 292. 20 ± 50. 00） × 106/ L 以及颅压 （265. 20±30. 79）mmH20 明显降低,差异具有统计学意义（ P〈 0 . 05乂结论脑室腹腔分流术治疗重症结核性脑膜炎合并 脑积水的效果明显,能够有效改善脑脊液参数、脑室体部宽度指数等相关指标水平,降低患者颅压.

Objective To investigate the effect of ventriculoperitoneal shunt in the treatment of severe tuberculous men-ingitis complicated with hydrocephalus. Methods A total of 16 patients with severe tuberculous meningitis complicated with hydrocephalus were enrolled in this study from December 2015 to April 2017. All subjects underwent ventriculoperitoneal shunt. The cerebrospinal fluid parameters, the ventricular body width index and the intracranial pressure were observed and compared before and after treatment. Results The body width index and chloride level after treatment were significantly higher than those before treatment （（2. 83土0. 18） vs （2. 1 2土0. 1 2 ）,（ 116. 90土2. 23） mmol/L vs （93. 52土3. 40） mmol/L,both P 〈C〇 . 05）. The adenosine dehydrogenase, cerebrospinal fluid protein, white blood cell count, and intracranial pressure after treatment were significantly decreased than those before treatment （（4. 16 ＋ 0. 12） U/L vs （10. 81 土 1. 10） U/L,（0. 45 ＋ 0. 09） g/Lvs （2.21±0. 50） g/L,（ 17. 4 0± 2. 60） X 106 /L vs （292. 20 ± 50. 00） X 106/L,（ 82. 22 ± 1 1 . 72） mmH20 vs （265. 20土30. 79） mmH20,all P〈C0. 05）. Conclusion Ventriculoperitoneal shunt has a great effect on severe tuberculous meningitis combined with hydrocephalus, which can effectively improve the cerebrospinal fluid parameters, ventricular body width index and reduce the intracranial pressure.