摘要：

目的 探讨腰大池和脑室外引流术对获得性免疫缺陷综合征（亦称艾滋病）合并隐球菌性脑膜炎患者颅内高压的治疗效果。方法 共138 例隐球菌性脑膜炎合并颅内高压患者［人类免疫缺陷病毒（HIV）阳性36 例、HIV 阴性102 例］，抗隐球菌治疗的同时，76 例行腰大池引流术、改良腰大池引流术或脑室外引流术（HIV 阳性17 例、HIV 阴性59 例），62 例行腰椎穿刺鞘内给药（HIV 阳性19 例、HIV 阴性43 例），比较引流组与鞘内给药组以及两组HIV 阳性亚组与HIV 阴性亚组患者引流管留置时间、脑脊液隐球菌培养转阴时间、并发症情况，并进行疗效评价。结果 引流组患者治疗1 周内颅内高压症状即明显改善。首次引流管置管中位时间30（17，35）d，其中HIV 阳性者与HIV 阴性者差异无统计学意义［28（15，32）d 对30（18，35）d；U = -1.459，P = 0.144］。引流组脑脊液隐球菌培养转阴中位时间41（26，58）d，其中HIV 阳性者与HIV 阴性者差异无统计学意义［46（28，66）d 对36（21，45）d；U = -1.608，P = 0.108］；鞘内给药组脑脊液隐球菌培养转阴中位时间42（32，65）d，其中HIV 阳性者与HIV 阴性者差异无统计学意义［52（38，68）d 对39（30，62）d；U = -0.401，P = 0.688］；而引流组与鞘内给药组差异有统计学意义（U = -2.117，P = 0.034）。引流组治疗总有效率为86.84%（66/76），其中HIV 阳性者与HIV 阴性者差异无统计学意义［14/17 对89.83%（53/59）；χ² = 0.172，P = 0.678］；鞘内给药组为72.58%（45/62），其中HIV阳性者与HIV 阴性者差异无统计学意义［8/19 对86.05%（37/43）；χ² = 0.023，P = 0.880］；而引流组与鞘内给药组差异有统计学意义（χ² = 4.413，P = 0.036）。结论 早期采用腰大池或脑室外引流术治疗艾滋病合并隐球菌性脑膜炎患者能够有效控制颅内高压、缩短有症状病程、提高临床疗效。

关键词: 引流术, 颅内高压, 获得性免疫缺陷综合征, 脑膜炎, 隐球菌性

Abstract:

Objective  To investigate the therapeutic effects of lumbar and ventricular drainage in the treatment of intracranial hypertension on acquired immunodeficiency syndrome (AIDS) patients with cryptococcal meningitis (CM).  Methods  A retrospective study was conducted on 138 cases of CM with intracranial hypertension, including 36 human immunodeficiency virus (HIV)-positive cases and 102 HIV-negative cases. All patients were given anti-infectious drugs. In drainage group, patients (N = 76, including 17 HIV-positive cases and 59 HIV-negative cases) were treated with lumbar, modified lumbar or ventricular drainage. In non-drainage group, patients (N = 62, including 19 HIV-positive cases and 43 HIV-negative cases) were treated with anti-fungal drugs by intrathecal injection through lumbar puncture. Comparative observation was done on indwelling catheter time, cryptococcal clearance time and complications between drainage and non-drainage groups, as well as HIV-positive and HIV-negative subgroups.  Results  The intracranial hypertension symptoms were improved significantly within one week in drainage group. The first indwelling catheter median time in drainage group was 30 (17, 35) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [28 (15, 32) d vs 30 (18, 35) d; U = -1.459, P = 0.144]. The cryptococcal clearance median time in drainage group was 41 (26, 58) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [46 (28, 66) d vs 36 (21, 45) d; U = -1.608, P = 0.108]. The cryptococcal clearance median time in non-drainage group was 42 (32, 65) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [52 (38, 68) d vs 39 (30, 62) d; U = -0.401, P = 0.688]. However, there was significant difference between drainage and non-drainage groups (U = -2.117, P = 0.034). The total effective rate of drainage group was 86.84% (66/76), and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [14/17 vs 89.83% (53/59); χ² = 0.172, P = 0.678]. The total effective rate of non-drainage group was 72.58% (45/62), and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [8/19 vs 86.05% (37/43); χ² = 0.023, P = 0.880]. There was significant difference between drainage and non-drainage groups (χ² = 4.413, P = 0.036).  Conclusions  Using lumbar or ventricular drainage to treat AIDS patients with CM in the early stage can effectively control intracranial hypertension, shorten the duration of symptoms, and significantly improve the clinical efficacy.

Key words: Drainage, Intracranial hypertension, Acquired immunodeficiency syndrome, Meningitis, cryptococcal