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早期腰大池置管治疗伴有恶性颅高压新型隐球菌性脑膜炎临床分析
引用本文:曾国勇,李广生,刘向红. 早期腰大池置管治疗伴有恶性颅高压新型隐球菌性脑膜炎临床分析[J]. 赣南医学院学报, 2009, 29(2): 192-193
作者姓名:曾国勇  李广生  刘向红
作者单位:赣州市人民医院神经内科,江西,赣州,341000;赣州市人民医院神经内科,江西,赣州,341000;赣州市人民医院神经内科,江西,赣州,341000
摘    要:目的:观察早期腰大池置管持续引流治疗伴有恶性颅高压的新型隐球菌性脑膜炎患者的临床效果。方法:对7例伴有恶性颅高压的新型隐球菌性脑膜炎患者采用早期腰大池置管持续引流(最长引流时间达4周),同时给予两性霉索-B静脉、鞘内注射及5-氟胞嘧啶口服等常规治疗方案,以隐球菌计数、墨汁染色阴性时间及临床症状改善情况为观察指标。结果:有头痛、呕吐、意识障碍的患者经早期腰大池置管持续引流后症状即刻减轻,所有患者精神状态短期内明显好转;1例视力障碍的患者经引流处理2天后视力基本正常,仅有1例遗留有轻度视力障碍。经联合治疗最后痊愈4例,好转3例。治愈的4例患者随访至今均无复发。结论:早期腰大池置管持续引流能有效降低新型隐球菌性脑膜炎颅内压,改善临床症状,为抗真菌治疗赢取时间。

关 键 词:新型隐球菌  脑膜炎  颅高压  置管

The Clinical Study of the Curative Effect of Drainage in Treating Cryptococcal Neoformans Meningitis Accompanying Uncontrollable Intracranial Hypertension
ZENG Guo-yong,LI Guang-sheng,LIU Xiang-hong. The Clinical Study of the Curative Effect of Drainage in Treating Cryptococcal Neoformans Meningitis Accompanying Uncontrollable Intracranial Hypertension[J]. Journal of Gannan Medical College, 2009, 29(2): 192-193
Authors:ZENG Guo-yong  LI Guang-sheng  LIU Xiang-hong
Affiliation:(Ganzhou People's Hospital, Ganzhou Jiangxi 341000)
Abstract:Objective:To study the curative effect of early continuous lumbar cisterna drainage on treating cryptococcal neoformans meningitis accompanying uncontrollable intracranial hypertension. Methods: 7 cases with cryptococcal neoformans meningitis accom panyiug uncontrollable intracranial hypertension patients were treated with early continuous lumbar cisterna cerebrespinal fluid drain- age, combining intravenous drips and intrathecal injection of amphotericin B and orally taken of fluorecytosine. The curative effect was assessed in terms of the counting of Cryptococcus,time of negative conversion of Cryptococcus in India ink stain, and the improving of clinical symptom. Results: Patients with headache, vomiting and conscious disturbance instantly relieved after early lumbar cisterna cerebrospinal fluid drainage, mental status turns much better in a short time in all the patients; one patient with visual disorder almost recovered 2 days later, and only one case remained slight visual disorder. In this 7 cases, 4 cases recovered,3 cases had significant effect eventually after the combination treatment. Conclusion: Early continuous lumbar cisterna drainage can effectively lower the intracranial pressure in cryptococcal neoformans meningitis, improve clinical symptom and win the time of treatment.
Keywords:cryptococcal neoformans  meningitis  intracranial hypertension  drainage
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