关键词: 引流术, 结核,脑膜, 脑脊液

Abstract:

Objective: To investigate the clinical effectiveness and safety of continuous lumbar cistern drainage with intrathecal injection on severe tubercular meningitis patients. Methods: A retrospective analysis was performed on data of 42 patients with severe tubercular meningitis admitted to Hebei Chest Hospital from August 1,2018 to October 1, 2021. The patients were divided into control group (n=21) and treatment group (n=21) according to whether continuous drainage of lumbar cistern was given. Control group was given routine anti-tuberculosis treatment and intrathecal injection. For treatment group, continuous lumbar cistern drainage was added, 14 days as one session of treatment. The two groups were compared before and after treatment in terms of recovery time of intracranial pressure, disturbance of consciousness, fever, headache, CSF ADA, CSF protein, and CSF neutrophils. Comparison was also done for mortality rate of control group and treatment group. Results: The average recovery time of fever in the treatment group was (6.24±4.07)d, significantly shorter than the control group ((11.65±3.02)d,t=-4.403, P<0.01). In the treatment group, the time of headache disappearance was 4.5 (0.5,8.5) d, the time of consciousness disorder recovery was 3 (0,7) d, the time of CSF ADA decreased to normal was 10 (0,21) d, the time of CSF protein decreased to normal was 35 (0,99) d, and the time of CSF neutrophil disappearance was 33 (0,85) d, which were all significantly better than the control group (10.5 (1.5,19.5) d, 29 (23,35) d, 18 (9,27) d, 94 (0,197) d and 100 (8,192) d), the differences were all statistically significant (Z=33.500, 169.000, 94.000, 338.500, 349.000, P values all <0.05). The recovery time of intracranial pressure was 21 (0,52) d in the treatment group and 27 (19,35) d in the control group, but difference between the two groups was not statistically significant (Z=241.500, P=0.597). The mortality of both groups was 4.7% (1/21). Conclusion: Continuous lumbar cistern drainage combined with intrathecal injection can shorten the fever time, promote consciousness recovery, shorten the recovery time of CSF ADA and protein, accelerate disappearance of CSF neutrophils, improve clinical symptoms and shorten the length of hospital stay of patients with severe tubercular meningitis.

Key words: Drainage, Tuberculosis, meninges, Cerebrospinal fluid