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目的探讨脑脊液负流量置换联合鞘内注射异烟肼和地塞米松治疗结核性脑膜炎的临床疗效。方法采用脑脊液负流量置换联合鞘内注射异烟肼和地塞米松治疗结核性脑膜炎患者32例(治疗组)和常规治疗30例(对照组),比较两组患者治疗8周末的临床表现、颅压水平、脑脊液性状及恢复正常时间和治疗1年后疗效等。结果治疗8周末,治疗组患者颅压及脑脊液蛋白质、白细胞数均明显低于对照组(P均<0.05)。治疗1年后治疗组总有效率90.6%,对照组总有效率66.7%,两组总有效率比较差异有统计学意义(P<0.05)。治疗组未发现与脑脊液负流量置换联合鞘内注药相关的并发症。治疗组患者在临床症状缓解、颅压降低、脑脊液性状改善等方面均优于对照组(P均<0.05)。结论脑脊液负流量置换联合鞘内注药是治疗结核性脑膜炎的一种简便、安全、有效的办法。
Objective To investigate the clinical efficacy of negative cerebrospinal fluid replacement combined with intrathecal isoniazid and dexamethasone in the treatment of tuberculous meningitis. Methods Thirty-two patients with tuberculous meningitis (control group) and 30 patients with tuberculous meningitis (control group) were treated with negative fluid flow replacement combined with intrathecal administration of isoniazid and dexamethasone. The clinical manifestations of the two groups were compared at the end of 8 weeks, Intracranial pressure, cerebrospinal fluid traits and normal time of recovery and the effect after 1 year of treatment. Results At the end of the 8th week, the intracranial pressure, cerebrospinal fluid protein and white blood cell count in the treatment group were significantly lower than those in the control group (all P <0.05). After treatment for 1 year, the total effective rate was 90.6% in the treatment group and 66.7% in the control group. The total effective rate was significantly different between the two groups (P <0.05). The treatment group found no complications associated with intrathecal administration of negative CSF flux replacement. Patients in the treatment group were better than the control group in relieving clinical symptoms, reducing intracranial pressure and improving cerebrospinal fluid (P <0.05). Conclusion Cerebrospinal fluid negative flow displacement combined with intrathecal injection is a simple, safe and effective method for the treatment of tuberculous meningitis.