Clinical analysis of continuous drainage in lumbar cistern for severe tuberculous meningitis

doi:10.19983/j.issn.2096-8493.20220041

Abstract

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

CLC Number:

R529.3

Meng Yizhe, Han Weixin, Li Junxia, Zhao Liming, Chen Yanqiang, He Hongyan. Clinical analysis of continuous drainage in lumbar cistern for severe tuberculous meningitis[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(6): 496-500. doi: 10.19983/j.issn.2096-8493.20220041

Figures/Tables 1

特征	治疗组	对照组	统计检验值	P值
年龄(岁, $x ˉ$ ±s)	39.9±16.9	40.5±16.5	t=0.120	0.905
体温(℃, $x ˉ$ ±s)	38.1±1.0	37.4±0.8	t=1.676	0.102
颅内压[mmH₂O,M(Q₁,Q₃)]	320(155,485)	250(85,415)	Z=168.500	0.188
发病时间[d,M(Q₁,Q₃)]	30(0,100)	51(0,129)	Z=227.500	0.860
脑脊液蛋白(g/L, $x ˉ$ ±s)	1.35±0.36	1.34±0.50	t=0.124	0.902
脑脊液中性粒细胞百分比(%, $x ˉ$ ±s)	38.0±26.1	33.1±23.5	t=0.634	0.530
脑脊液ADA[U/L,M(Q₁,Q₃)]	5(0,10.45)	6(0,12.58)	Z=216.000	0.910

References 17

[1]	Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev, 2016, 4(4):CD002244. doi:10.1002/14651858.CD002244. doi: 10.1002/14651858.CD002244 URL
[2]	Davis AG, Rohlwink UK, Proust A, et al. The pathogenesis of tuberculous meningitis. J Leukoc Biol, 2019, 105(2):267-280. doi:10.1002/JLB.MR0318-102R. doi: 10.1002/JLB.MR0318-102R URL
[3]	Donovan J, Thanh NT, Thwaites GE, et al. Severe paradoxical reaction in tuberculous meningitis. IDCases, 2020, 23:e01009. doi:10.1016/j.idcr.2020.e01009. doi: 10.1016/j.idcr.2020.e01009 URL
[4]	赵娟娟. 结核性脑膜炎的诊断与治疗进展. 中外医学研究, 2020, 18(16):180-183. doi:10.14033/j.cnki.cfmr.2020.16.073. doi: 10.14033/j.cnki.cfmr.2020.16.073 URL
[5]	中华医学会结核病学分会结核性脑膜炎专业委员会. 2019中国中枢神经系统结核病诊疗指南. 中国传染病学, 2020, 38(7):400-408. doi:10.3760/cma.j.cn311365-20200606-00645. doi: 10.3760/cma.j.cn311365-20200606-00645 URL
[6]	Philip N, William T, John DV. Diagnosis of tuberculous meningitis: challenges and promises. Malays J Pathol, 2015, 37(1):1-9. pmid: 25890607
[7]	Ma W, Li C, Cong L. Dynamic Curve Analysis of Indicators Related to Lumbar Cistern Drainage for Postoperative Meningitis. World Neurosurg, 2021, 151:e299-e307. doi:10.1016/j.Wneu.2021.04.031. doi: 10.1016/j.Wneu.2021.04.031 URL
[8]	何嘉明, 候庆石, 罗灼明, 等. 腰大池持续引流联合抗菌药治疗颅脑术后颅内感染的临床观察. 数理医药学杂志, 2021, 34(10):1432-1434. doi:10.3969/j.issn.1004-4337.2021.10.004. doi: 10.3969/j.issn.1004-4337.2021.10.004 URL
[9]	孙静, 刘燕, 黄远成. 培氟沙星联合抗结核药治疗重症结核性脑膜脑炎. 江苏医药, 1999, 25(12):951. doi:CNKI:SUN:YIYA.0.1999-12v. doi: CNKI:SUN:YIYA.0.1999-12v URL
[10]	李伟, 王勇. 腰大池置管引流在结核性脑膜炎治疗中的应用效果. 中国继续医学教育, 2019, 11(4):92-94. doi:10.3969/j.issn.1674-9308.2019.04.042. doi: 10.3969/j.issn.1674-9308.2019.04.042 URL
[11]	Lampros A, Baille G, De Broucker T.Tuberculous meningitis: when should we consider depletive lumbar punctures. Infect Dis Now, 2021, 51(4):401-402. doi:10.1016/j.idnow.2020.12.006. doi: 10.1016/j.idnow.2020.12.006 URL
[12]	Chen QH, Lin D, Yu QG, et al. Efficacy of lumbar cistern drainage combined with intrathecal antibiotherapy for the treatment of ventriculo-subarachnoid infections following surgery for hypertensive intracerebral hemorrhage. Neuro-chirurgie, 2017, 63(1):13-16. doi:10.1016/j.neuchi.2016.05.002. doi: 10.1016/j.neuchi.2016.05.002 URL
[13]	陈均昌, 包陆君, 卢家璋, 等. 腰大池置管脑脊液持续外引流术治疗外伤性蛛网膜下腔出血的疗效. 中国现代药物应用, 2017, 11(9):43-44. doi:10.14164/j.cnki.cn11-5581/r.2017.09.020. doi: 10.14164/j.cnki.cn11-5581/r.2017.09.020 URL
[14]	Yang Z, Du L, Liu R, et al. Evaluationg of Continuous Irrigation and Drainage with Double Cavity Sleeve Tube in the Treatment of Brain Abscess:46 Patients Report. World Neurosurgery, 2017, 106(10):231-239. doi:10.1016/j.wneu.2017.05.117. doi: 10.1016/j.wneu.2017.05.117 URL
[15]	王新宏, 任联盟, 白广红. 腰大池置管连续给药治疗结核性脑膜炎疗效及安全性分析. 西南国防医药, 2016, 26 (2):142-145. doi:10.3969/j.issn.1004-0188.2016.02.010. doi: 10.3969/j.issn.1004-0188.2016.02.010 URL
[16]	吕翠荣. 利奈唑胺联合抗结核治疗对结核性脑膜炎患者肝功能及脑脊液腺苷脱氨酶水平的影响. 中国实用医药, 2021, 16(26):147-149. doi:10.14163/j.cnki.11-5547/r.2021.26.055. doi: 10.14163/j.cnki.11-5547/r.2021.26.055 URL
[17]	张继萍, 任丽娟, 李永利, 等. 结核性脑膜炎临床表现及脑脊液细胞学结果分析. 皖南医学院学报, 2015, 34(5):461-463. doi:10.3969/j.issn.1002-0217.2015.05.017. doi: 10.3969/j.issn.1002-0217.2015.05.017 URL