脑脊液置换联合鞘内注药治疗结核性脑膜炎的疗效观察

目的探讨脑脊液置换联合鞘内注药治疗结核性脑膜炎的应用。方法将39例结核性脑膜炎患者随机分为2组,观察组21例,对照组18例,两组给予常规抗结核治疗,观察组在常规治疗基础上给予脑脊液置换联合鞘内给药,治疗2个月后观察疗效。结果观察组临床症状缓解,脑脊液蛋白恢复正常的时间短于对照组。结论结核性脑膜炎常规治疗基础上给予脑脊液置换联合鞘内给药,使患者病程缩短,减少并发症,提高治愈率,改善预后。是治疗结核性脑膜炎行之有效的方法之一。     

脑脊液置换联合鞘内注药治疗结核性脑膜炎42例分析

目的探讨和研究脑脊液置换联合鞘内注药对结核性脑膜炎的治疗效果。方法选取本院近年来收治的42例结核性脑膜炎患者的临床资料,按照随机分组的原则将其分为观察组和对照组各21例,其中对照组给予抗结核和保肝、激素以及脱水剂等常规药物进行治疗;观察组在此基础上加用脑脊液置换与鞘内注药进行治疗．在治疗结束后统计两组患者的治疗情况和相关指标并进行对比。结果观察组的总有效率和显效率分别为95．24％和71．43％．对照组的总有效率和显效率分别为71．43％和52．38％,两组对比差异具有统计学意义（P〈0．05）。同时观察组患者的临床症状消失时间、压力、脑脊液细胞和脑脊液蛋白的恢复时间等均明显优于对照组．差异具有统计学意义（P〈0．05）。结论脑脊液置换联合鞘内注药对结核性脑膜炎的治疗有着令人满意的效果,是安全可靠的,值得在临床上加以推广和应用。     

鞘内注药联合人工脑脊液置换在结核性脑膜炎治疗中的应用

目的对结核性脑膜炎患者采用鞘内注药与人工脑脊液置换同时治疗的效果进行分析探究。方法选取在我院接受治疗的100例患有结核性脑膜炎患者作为研究对象,将其平均分为试验组与对照组,给予生理盐水与鞘内注药对对照组治疗,给予人工脑脊液与鞘内注药对试验组治疗,对比分析两组研究对象的临床疗效情况。结果试验组患者总有效率(96.00%)与对照组患者的总有效率(66.00%)相比明显较高,结果有统计学意义(P<0.05)。结论对结核性脑膜炎患者采用鞘内注药与人工脑脊液置换同时治疗的效果显著,安全可靠,值得推广。     

脑脊液置换加鞘内给药治疗结核性脑膜炎的护理

结核性脑膜炎 (结脑 )系指结核菌经血流到达脑膜直接引起 ,或是结核菌进入脑内后在皮质、软脑膜脑实质、脉胳丛等处形成结核病灶 ,当病灶破溃时可以排出干酪样物质和结核菌到蛛网膜下腔引起结核性脑膜炎[1 ] 。结核性脑膜炎是肺外结核中的重症结核病 ,其发病率和病死率较高 ,有效抗结核药物在并用激素后 ,虽使其病死率由 30 %～ 4 0 %降至 15 %以下 ,但致残率仍较高 [2 ]。为此 ,我科于 1996年以来采用脑脊液置换加鞘内给药治疗结脑 ,取得满意疗效 ,现将护理体会总结如下。1　临床资料本组 2 1例 ,其中男 12例 ,女 9例 ;年龄 17～ 6 6岁 ,平…     

脑脊液置换配合鞘内给药治疗结核性脑膜炎36例临床效果

目的探讨脑脊液置换配合鞘内给药治疗结核性脑膜炎临床效果。方法选择72例结核性脑膜炎患者,上述患者随机分为观察组和对照组。观察组在常规抗结核治疗基础上,实施脑脊液置换配合鞘内注射给药,对照组采用常规治疗。观察两组治疗效果和症状消退时间。结果观察组总有效率为91.6%,对照组总有效率为72.2%,观察组总有效率显著高于对照组,差异有统计学意义(P<0.05)。观察组体温恢复时间、颅内压恢复时间及脑脊液检查恢复正常时间均早于对照组,差异有统计学意义(P<0.05)。结论脑脊液置换配合鞘内给药治疗结核性脑膜炎疗效显著,能够缩短临床症状消退时间,促使脑脊液尽快恢复正常,值得借鉴。     

脑脊液置换联合鞘内注药治疗结核性脑膜炎80例

结核性脑膜炎是中枢神经系统结核感染的常见类型,临床症状严重,死亡率高,后遗症多,治疗较困难,疗效不甚理想。近年来我们采用脑脊液置换联合鞘内注药治疗获得较满意疗效。现将我院2001～2002年收治的80例病例报告如下。     

脑脊液置换配合鞘内给药治疗结核性脑膜炎临床效果评价

目的探讨脑脊液置换配合鞘内给药治疗结核性脑膜炎的临床效果。方法选择30例结核性脑膜炎患者,随机分为观察组和对照组各15例,对照组采用常规抗结核药物治疗,观察组在此基础上加用脑脊液置换配合鞘内给药,比较两组疗效。结果观察组治愈率为73.3%(11/15),好转率为20%(3/15),总有效率为93.3%(14/15);对照组治愈率为46.7%(7/15),好转率为26.7%(4/15),总有效率为73.3%(11/15),两组比较差异有统计学意义(P<0.05),观察组疗效要优于对照组。结论脑脊液置换配合鞘内给药治疗结核性脑膜炎效果确切,值得在临床使用。     

结核性脑膜炎患者应用脑脊液置换联合鞘内注药的临床疗效研究

目的 探讨脑脊液置换联合鞘内注药对结核性脑膜炎的临床疗效.方法 选择本院2013年2月至2015年1月收治的91例结核性脑膜炎患者作为研究对象,按照随机数字表分为两组:对照组45例采用常规抗结核治疗,而观察组46例则在常规治疗基础上应用脑脊液置换联合鞘内注射药物进行治疗.比较两组临床疗效,并观察不良反应发生情况.结果 治疗后,观察组总有效率为95.7％,明显高于对照组,差异有统计学意义(P＜0.05);观察组脑脊液指标、症状缓解时间等均优于对照组,组间差异具有统计学意义(P＜0.05);两组均未见明显不良反应.结论 脑脊液置换联合鞘内注射药物能够促进患者的脑脊液指标的恢复,提高治疗效率,有效改善结核性脑膜炎患者预后,值得临床应用.     

脑脊液置换并鞘内注药治疗重症结核性脑膜炎26例

1995-2003年应用不等量脑脊液置换鞘内注药治疗Ⅲ期重症结核性脑膜炎(结脑)26例，现将结果报道如下。     

脑脊液置换联合鞘内注射治疗结核性脑膜炎的临床疗效评价

目的探讨对结核性脑膜炎使用脑脊液置换联合鞘内注射治疗的效果。方法按照奇偶分组法将我院收治的50例结核性脑膜炎患者进行均分2组,各25例,选取结核性脑膜炎患者的时间为2014年8月至2017年8月。将使用常规治疗的患者作为参照组,将使用脑脊液置换联合鞘内注射治疗的患者作为实验组。分析2组临床疗效、脑脊液生化、白细胞数目以及压力等。结果与实验组相比较,参照组临床疗效较低,蛋白含量较高,糖含量较低,氯化物值较低,白细胞值较高以及压力较高,组间数据对比差异性显著(P <0.05)。结论对结核性脑膜炎患者采取脑脊液置换联合鞘内注射治疗的效果较明显。     

鞘内置管脑脊液置换与反复腰穿放脑脊液分别鞘内注药治疗结核性脑膜炎的疗效比较

目的探讨鞘内置管脑脊液置换与反复腰穿放脑脊液分别鞘内注药治疗结核性脑膜炎的疗效。方法在常规综合治疗的基础上,对照组采用反复腰穿放脑脊液并鞘内注药,观察组采用鞘内置管脑脊液置换加鞘内注药。结果观察组总有效率(93.1%)明显高于对照组(73.0%)(P<0.01);观察组脑脊液压力恢复正常和住院时间均明显短于对照组(P<0.01);对照组不良反应(5例)明显多于观察组(0例)(P<0.05)。结论相比反复腰穿放脑脊液,鞘内置管脑脊液置换疗效高,疗程短,不良反应少,值得临床推广应用。     

鞘内应用辅助药物复合局部麻醉药在蛛网膜下腔阻滞中的研究进展

在蛛网膜下腔阻滞中,影响阻滞平面和效果的最主要因素是药物总剂量。然而,局部麻醉药剂量过大易引起很多不良反应,局麻药剂量过小会导致阻滞平面和效果不足。现有的文献表明,已经有很多减少局部麻醉药剂量同时添加一些鞘内辅助药物如右美托咪定、阿片类药物、氯胺酮等来提高阻滞效果的试验,使用这些辅助用药可以延长阻滞时间,提高腰麻成功率及患者的满意度,与全麻相比,可以减少耗材的使用以及加快患者恢复。现主要对鞘内应用辅助药物复合局部麻醉药在腰麻中的研究进展进行综述。     

脑膜炎患儿脑脊液中NO含量的测定及临床意义

目的：探讨病毒性脑膜炎（病脑）、结核性脑膜炎（结脑）、化脓性脑膜炎（化脑）患儿脑脊液中ＮＯ含量及临床意义。方法：采用比色法测定病脑（１８例）、结脑（９例）、化脑（１０例）,对照组（１１例）脑脊液中ＮＯ浓度。结果：病脑、化脑,结脑脑脊液中ＮＯ浓度较对照组显著性升高,化脑脑脊液中ＮＯ浓度较病脑,结脑显著升高,差异均有显著意义（Ｐ〈０．０１）。结论：ＮＯ参与了小儿中枢神经系统感染性疾病的病理生理过程,并     

Outcomes of adjunctive therapy with intrathecal or intraventricular administration of colistin for post-neurosurgical meningitis and ventriculitis due to carbapenem-resistant acinetobacter baumannii

The efficacy and safety of intrathecal (ITH) or intraventricular (IVT) colistin in addition to intravenous (IV) colistin for meningitis and ventriculitis due to carbapenem-resistant Acinetobacter baumannii (CRAB) is unclear. In this retrospective observational study of 40 patients with post-neurosurgical meningitis and ventriculitis due to CRAB, 33 patients without concomitant infection received appropriate dosage regimens of IV colistin. Of the 33 patients, 17 received additional ITH/IVT colistin and 16 received only IV colistin. The 14-day, 30-day and in-hospital mortality rates were nominally lower for patients who received ITH/IVT colistin adjunctive therapy versus patients who received only IV colistin (24% vs. 38%, 29% vs. 56% and 29% vs. 56%, respectively). The costs of treatment were significantly lower, the lengths of hospital and intensive care unit (ICU) stay were significantly shorter, and the number of ventilator days was significantly less among patients who received ITH/IVT colistin compared with patients who did not receive ITH/IVT colistin. The initial Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were associated with 30-day mortality with odds ratios (95% confidence intervals) of 1.21 (1.08–1.46) and 0.77 (0.44–0.85), respectively. Chemical meningitis from ITH/IVT colistin was mild and resolved spontaneously. Treatment of post-neurosurgical CRAB meningitis and ventriculitis with ITH/IVT colistin as an adjunct to IV colistin was associated with shorter lengths of hospital and ICU stay and a trend to lower mortality, especially among severely ill patients.     

Synthetic investigational new drugs for the treatment of tuberculosis

Introduction: Tuberculosis (TB) is a major global health concern. And while there are treatments already on the market, there is a demand for new drugs that are effective and safe against Mycobacterium tuberculosis, which reduce the number of drugs and the duration of treatment in both drug-susceptible TB and multidrug-resistant TB (MDR-TB).

Area covered: This review covers promising novel investigational TB drugs that are currently under development. Specifically, the authors review the efficacy of novel agents for the treatment of TB in preclinical, phase I and phase II clinical trials. The authors also review the safety and tolerability profiles of these drugs.

Expert opinion: Bedaquiline and delamanid are the most promising novel drugs for the treatment of MDR-TB, each having high efficacy and tolerability. However, the best regimen for achieving better outcomes and reducing adverse drug reactions remains to be determined, with safety concerns regarding cardiac events due to QT prolongation still to be addressed. Pretomanid is a novel drug that potentially shortens the duration of treatment in both drug-susceptible and drug-resistant TB in combination with moxifloxacin and pyrazinamide. Linezolid shows marked efficacy in the treatment of MDR-TB and extensively drug-resistant TB (XDR-TB), but the drug is known to cause significant adverse drug reactions, including peripheral neuropathy, optic neuropathy and myelosuppression. These adverse reactions must be considered prior to prescribing long-term usage of this drug.     

结核性脑膜炎患者脑脊液中左氧氟沙星浓度监测分析

目的评价结核性脑膜炎(结脑)患者脑脊液中左氧氟沙星浓度监测的临床意义。方法运用高效液相色谱法测定8例结脑患者脑脊液中左氧氟沙星峰浓度时间(tmax)左右3个时间点(2、4、6 h)的浓度。结果结脑患者脑脊液tmax左右3个时间点的平均左氧氟沙星浓度分别是(0.94±0.39)(2 h)、(2.36±0.42)(4 h)、(2.14±0.32)(6 h)μg·mL-1,所有测定值均高于最小抑菌浓度(MIC,0.5μg·mL-1)。每位结核性脑膜炎患者tmax左右3个时间点的最大浓度均高于最小杀菌浓度(MBC,1.0μg·mL-1)。结论结核性脑膜炎患者口服左氧氟沙星400 mg,1次·d-1,脑脊液中浓度能达到治疗水平。     

New drugs being developed for the treatment of tuberculosis

More than one-third of the world is infected with tuberculosis (TB) and 5000 people die of TB everyday. Of the many diarylquinolones shown to be effective at inhibiting the multiple-cycle growth of Mycobacterium tuberculosis, R-207910 was the most active and was chosen as the lead compound. In the non-established infection mouse TB model, a single dose of R-207910 50 mg/kg had a bacteriostatic effect, and a bactericidal effect was observed at 100 mg/kg. In the established infection mouse model, treatment was started 12 – 14 days after infection, and when added to the triple therapy of isoniazid, rifampin and pyrazinamide or substituted for any component of the triple therapy, R-207910 increased the effectiveness. As ethambutol is chemically simple, and only has modest potency in treating TB, it was considered to be amenable to optimisation by combinatorial chemistry, and from the analogues synthesised that inhibited the growth of M. tuberculosis, SQ-109 was eventually selected as the lead compound for further testing. In female mice infected with M. tuberculosis H37Rv by tail-vein injection, treatment with SQ-109 25 mg p.o. initiated 20 days later for 5 days/week for 4 weeks reduced the counts by 1.87 log units, which was slightly more than with ethambutol 100 mg (1.67 log units). These results indicate that exciting new drugs are under development for the treatment of TB.