Ommaya囊等侧脑室介入法治疗结核性脑膜脑炎并脑积水的疗效分析

The Paracele Intervention Methods of Ommaya Capsule etc.to Treat Tuberculous Meningoencephalitis with Hydrocephalus

采用ommaya囊/侧脑室外引流装置引流脑脊液,并联合侧脑室注射异烟肼的方法,探究对结核性脑膜脑炎并脑积水的疗效.抽取2017年3月至2019年3月昆明市第三人民医院收治的41例结核性脑膜脑炎并脑积水患者,进行回顾性疗效分析.对照组为常规抗结核治疗3周;治疗组ommaya囊治疗组及侧脑室外引流治疗组均为常规抗结核治疗+侧脑室脑脊液引流+侧脑室注射异烟肼3周.对比三组治疗前及后第3天,第1、3、4、8周临床表现,腰池脑脊液压力、生化、常规的变化,不良反应,第4、8周头颅MRI的变化等.临床症状缓解时间治疗组与对照组比较均有显著差异(P<0.05);治疗后第3天、1周、3周、4周、8周,治疗组腰池脑压>180 mmH2O及≤180mmH2O的病例数,以及脑脊液葡萄糖及氯化物、蛋白、细胞数的改变,与对照组比较均有显著差异(P<0.05);治疗第4周、第8周时治疗组头颅MRI与对照组比较均有明显好转(P<0.05);治疗组间对比无显著差异(P>0.05).治疗组并发症及不良反应病例数与对照组比较均有显著差异(P<0.05),治疗组间颅内逆行感染对比有显著差异(P<0.05);治疗后第4、第8周脑压较前上升(P<0.05).治疗组疗效与对照组比较有统计学差异(P<0.05).ommaya囊/侧脑室外引流联合侧脑室注射异烟肼治疗结核性脑膜脑炎并脑积水,能快速缓解临床症状,降低颅内压力,改善脑脊液常规及生化指标,净化脑脊液,促进病灶吸收.侧脑室外引流方法造成颅内逆行感染的风险大;ommaya囊更安全,能长期使用进行治疗,可行性更强.

This paper investigates the effect of tuberculous meningoencephalitis combined with hydrocephalus by using ommaya capsule/lateral cerebral drainage device to drain cerebrospinal fluid and injecting isoniazid into the lateral ventricle.Forty-one patients in our hospital with tuberculous meningoencephalitis and hydrocephalus were selected and retrospectively analyzed from March 2017 to March 2019.The control group received conventional anti-tuberculosis treatment for 3 weeks.The ommaya sac group and the lateral cerebral drainage group in the treatment group were treated with conventional anti-tuberculosis treatment+lateral ventricle cerebrospinal fluid drainage+lateral ventricle injection of isoniazid for 3 weeks.The clinical manifestations of the first,third,fourth,and eighth weeks before and after the three groups of treatment,Lumbar cerebrospinal fluid pressure,biochemical,routine changes,adverse reactions,changes in cranial MRI at 4 and 8 weeks.The clinical symptom relief time was significantly different between the treatment group and the control group(P<0.05).On the 3 rd day,1 st,3 rd,4 th,and 8 th week after treatment,the number of cases in which the lumbar pool pressure of over 180 mmH2O or under 180 H2O,and the cerebrospinal fluid of glucose,chloride,protein and cell number in the two treatment groups was significantly different from the control group.(P<0.05);there was no significant different between the two treatment groups(P>0.05).The MRI of the treatment group was significantly improved compared with the control group at 4 and 8 weeks(P<0.05).There was no significant different between the two treatment groups(P>0.05).The number of adverse reactions is significantly different from the control group(P<0.05),and intracranial retrograde infection has a significant difference between the two treatment groups(P<0.05).On the 4 th,and 8 th week after treatment,the brain pressure increase than before(P<0.05).The two treatment of total effective ration has a significant different from the control group(P<0.05).Ommaya capsule/lateral cerebral drainage combined with lateral ventricle injection of isoniazid for the treatment of tuberculous meningoencephalitis with hydrocephalus is effective.It can quickly relieve clinical symptoms,reduce intracranial pressure,improve routine and biochemical indicators of cerebrospinal fluid,purify cerebrospinal fluid,and promote the absorption of lesions.The lateral drainage of the lateral cerebral ventricle causes a high risk of intracranial retrograde infection,and the ommaya capsule is safer,more effective in long-term maintenance and more viable.