两性霉素B脂质体鞘内注射治疗新型隐球菌性脑膜炎疗效观察

目的：探讨两性霉素B鞘内注射治疗新型隐球菌性脑膜炎的可行性。方法：将常规静脉注射两性霉素B后、病情仍难以控制的（脑脊液中新型隐球菌性仍难以转阴,颅内高压持续不降）24例新型隐球菌性脑膜炎患者,随机分为两性霉素B鞘内注射组、两性霉素B脂质体鞘内注射组,鞘内注射剂量从0.1 mg开始,逐渐增加剂量,直到出现难以耐受的不良反应或每次注射剂量达到1 mg。结果：患者可以较好地耐受两性霉素B脂质体鞘内注射,鞘内注射两性霉素B脂质体发生不良反应的几率及严重程度明显低于普通两性霉素B。结论：两性霉素B脂质体鞘内注射治疗新型隐球菌性脑膜炎具有可行性。

Feasibility of Treating Cryptococcus Neoformans Meningitis with Intrathecal Lipid Amphotericin B

OBJECTIVE： To explore the feasibility of intrathecal lipid amphotericin B in the management of cryptococcus neoformans meningitis. METHODS： 24 patients with cryptococcus neoformans meningitis showing no recovery after treatment with routine intravenous administration of amphotericin B （AMB） （i. e. cryptococcus neoformans in cerebrospinal fluid were positive and acute intracranial hypertension was continued） were randomly assigned to receive intrathecal administration of AMB or liposomal amphotericin B with an initial dose of 0.1 mg/d, which increased step by step until intolerable adverse effect occurred or the 1.0 mg/d dose reached. RESULTS： The patients can tolerate intrathecal administration of liposomal amphotericin B well, and the incidence and severity of adverse effects of liposomal amphotericin B were significantly lower as compared with common amphotericin B. CONCLUSION： It is feasible for intrathccal liposomal amphotcricin B to treat cryptococcus neoformans meningitis.