地塞米松联合异烟肼鞘内注射治疗结核性脑膜炎效果观察

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1、地塞米松联合异烟肼鞘内注射治疗结核性脑膜炎效果观察鋪孟艺哲保定市第一中心医院东院检验科河北省胸科医院神经内科摘要：目的探讨地塞米松联合异烟胼鞘内注射治疗结核性脑膜炎(TBM)的效果及对脑脊液的影响。方法选择保定市第一中心医院2015年3月一2017年2月收治的TBM93例，按治疗方法分为观察组47例和对照组46例，两组均给予常规抗结核方案，对照组在此基础上给予地塞米松静脉滴注，观察组在对照组基础上给予地塞米松联合异烟胼鞘内注射。观察两组临床疗效、治疗前后脑脊液指标改善情况及临床症状和体征转归时间，并评价安全性。结果观察组总

2、有效率高于对照组(P<0.05)。两组治疗后脑脊液氯化物和葡萄糖均较治疗前升高，细胞数和蛋白质均较治疗前降低，iL观察组改善程度优于对照组(P<0.05,P〈0.01)。观察组脑脊液指标恢复正常时间及临床症状体征转归时间均短于对照组(P<0.01)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论地塞米松联合异烟肼鞘内注射治疗TBM能明显改善脑脊液常规水平，临床症状改善较快，且安全性较高。关键词：结核，脑膜;地塞米松;异烟胼;注射，脊髓;脑脊液常规;收稿日期：2017-06-20基金：河北省青年科技课题(201

3、50140)EffectObservationofDexamethasoneCombinedwithIsoniazidbyIntrathecalInjectioninTreatmentofPatientswithTuberculousMeningitisLIQianZHANGJian—shuMENGYi_zheDepartmentofClinicalLaboratory,EastDistrictoftheFirstCentralHospitalofBaoding;DepartmentofNeurology，HebeiPro

4、vincialChestHospital;Abstract：ObjectiveToinvestigateeffectofDexamethasonecombinedwithIsoniazidbyintrathecalinjectionintreatmentofpatientswithtuberculousmeningitis(TBM)anditseffectoncerebrospinalfluid.MethodsAtotalof93TBMpatientsadmittedduringMarch2015andFebruary20

5、17weredividedintoobservationgroup(n=47)andcontrolgroup(n=46)accordingtodifferenttreatments.Allpatientsreceivedroutineanti-tuberculosistreatment.ControlgroupwastreatedwithDexamethasonebyintravenousinfusion,whileobservationgroupwastreatedwithDexamethasonebyintraveno

6、usinfusioncombinedwithTsoniazidbyintrathecalinjection.Tntwogroups,changesofcerebrospinalfluidindexes,returningtonormaltimesofclinicalsingsandsymptomsbeforeandaftertreatmentwereobserved,andsafetywasalsoevaluated.ResultsThetotaleffectiverateinobservationgroupwassign

7、ificantlyhigherthanthatincontrolgroup(P<0.05).Aftertreatment,chloridesandglucoselevelsincerebrospinalfluidweresignificantlyincreased,whilecellnumbersandproteinlevelsweresignificantlydecreasedcomparedwiththosebeforetreatmentintwogroups,andtheimprovementconditionsin

8、observationgroupwerebetterthanthoseincontrolgroup(P>0.05,P>0.01).Aftertreatment,returningtonormaltimesofcerebrospinalfluidindicators,clinicalsingsandsym