重症结核性脑积液患者脑脊液灌洗置换治疗的疗效观察

目的探讨脑脊液灌洗置换疗法对重症结核性脑积液的疗效，并对其可行性及安全性进行评估。方法对确诊的35例重症结核性脑膜炎合并脑积液患者行侧脑室外引流术，灌洗置换的17例为治疗组，未灌洗置换的18例为对照组。治疗组在对照组治疗方案的基础上用代脑脊液行脑脊液灌洗置换治疗，并对两组脑脊液、影像学检查及临床疗效进行比较，治疗组同时观察治疗时的不良反应，所有患者随访6个月。结果治疗组和对照组治疗和随访期间1、3、6个月各项观察指标结果如下，脑脊液压力：治疗组（170±22）mmH2O、（185±21）mmH20、（182±23）mmH2O；对照组（202±22）rninH2O、（211±24）mmH20、（188±21）mmH2O；两组比较随访1、3个月脑脊液压力差异有统计学意义（t值分别为-3．329、-2．436，P值均〈0．05）。白细胞：治疗组（74±13）×10/6／L（58±13）×10/6／L（39±10）×10/6／L；对照组（115土16）×10。／L、（854-10）×10/6／L、（55±12）×10/6／L；两组比较差异均有统计学意义（t值分别为-5．190、-5．173、-5．173，P值均〈0．001）。蛋白含量：治疗组（0．52士0．32）g／L、（1．00±0．41）g／L、（0．45±0．28）g／L；对照组（0．89±0．45）g／L、（2．02±0．67）g／L、（0．75±0．45）g／L；两组比较差异均有统计学意义（t值分别为-2．407、-3．247、-2．434，P值均〈0．05）。葡萄糖含量：治疗组（2．47±0．58）mmol／L、（2．384-0．50）mmol／L、（2．56±0．52）mmol／L；对照组（2．16±0．54）mmol／L、（1．95±0．47）mmo／L、（2．12±0．51）mmol／L.两组比较随访3、6个月差异有统计学意义（t值分别为-2．468、-2．476，P值均〈0．05）。氯化物含量：治疗组（119±15）mmol／L、（128±17）mmol／L、（129±16）mmoi／L；对照组（110±14）mmol／L、（115±18）mmol／L、（124±17）retool／L；两组比较随访3个月差异有统计学意义t=2．441，P〈0．05）。两组患者自出院之日起随访6个月时，治疗组临床治愈6例，有效7例，死亡4例；对照组临床治愈5例，有效6例，死亡7例。治疗组平均脑脊液灌洗置换次数为6．5次，出现不良反应3例次，表现为短暂寒战、一过性发热、抽搐，经过对症处理消失。结论脑脊液灌洗置换治疗重症结核性脑积液简单易行，安全可靠，疗效较好，有进一步探讨的必要。

Efficacy of cerebrospinal fluid lavage replacement in severe tuberculous hydrocephalus

Objective To explore the effect of cerebrospinal fluid （CSF） lavage replacement in patients with severe tuberculous hydrocephalus and evaluate its feasibility and safety. Methods Thirty-five patients diagnosed with severe tuberculosis hydrocephalus were performed with external ventricle drainage operation. Seventeen pa- tients received treatment with cerebrospinal fluid lavage replacement were assigned as the treatment group, and 18 cases untreated were assigned as the control group. CSF results, imaging examination and clinical outcome of two groups were observed and compared. Side effects of the treatment group were also observed. All cases in both groups have been followed up for half a year. Results Significant differences were found between the two groups in CSF examinations during 1, 3, and 6 months＇ follow-up. CSF pressure were （170±22） mm H20,（185±21）mm H2O, （182±23）mm H20 in the treatment group and （202±22）mm H20, （211±24）mm H20, （1884±21）mm H2O in the control group, in which t=-3. 329, t= -2. 436, P〈0.05 when compared 1 and 3 months＇ results. WBC were （74±13） × 106/L, （58±13） ×106/L, （39± 10） ×106/L in the treatment group and （115±16））〈 106/L, （85±10））〈 10（55±12）×106/L in the control group （t=-5.190, t=-5.173, t=- 5.173,P〈0.001）. Protein content were （0. 524-0.32）g/L, （1. 004-0.41）g/L, （0. 454±0.28）g/L in the treatment group and（0. 89±0. 45）g/L, （2.02±0. 67）g/L,（0. 75±0. 45）g/L in the control group （t=-2. 407,t=3. 247,t=--2. 434, P〈0. 05）. Glucose con- tent were （2.47±0.58）retool/L, （2.38±0.50）mmol/L, （2.56±0.52）mmol/L in the treatment group and （2.16± 0. 54）mmol/L, （1.95±0. 47）mmol/L, （2. 12±0. 51）mmol/L in the control group （t= -2. 468,t=-2. 476,P〈 0.05 when compared 3 and 6 months）. Chloride content were （ 119 ±15） mmol/L, （ 128 ± 17） mmol/L, （ 129 ! 16）mmol/L in the treatment group and （1104±14）mmoI/L, （115±18）mmol/L, （124± 17）mmol/L in the control group （t=-2. 441,P〈0.05 compared 3 months）. After 6 months of follow-up from leaving hospital, 6 cases in the treatment group were cured, 7 cases were effective and 4 cases died. In the contrast control group, 5 cases were cured, 6 cases were effective and 7 cases died. All patients in the treatment group were treated with the cerebrospi nal fluid lavage replacement for 6.5 times, among which 3 cases were suffered from side effects including brief chills, transient fever and convulsions. All side effects disappeared after symptomatic treatment. Conclusion Ce- rebrospinal fluid lavage replacement is an effective, simply practicable and safe treatment for severe tuberculous hy- drocephalus. This treatment may reduce the mortality of severe tuberculous hydrocephalus and the further study is necessary.