关键词: 结核, 脑膜/并发症, 脑积液, 脑室引流术, 灌洗

Abstract: Objective  To explore the effect of cerebrospinal fluid (CSF) lavage replacement in patients with severe tuberculous hydrocephalus and evaluate its feasibility and safety. Methods  Thirty-five patients diagnosed with severe tuberculosis hydrocephalus were performed with external ventricle drainage operation. Seventeen patients received treatment with cerebrospinal fluid lavage replacement were assigned as the treatment group, and 18 cases untreated were assigned as the control group. CSF results, imaging examination and clinical outcome of two groups were observed and compared. Side effects of the treatment group were also observed. All cases in both groups have been followed up for half a year. Results  Significant differences were found between the two groups in CSF examinations during 1, 3, and 6 months’ follow-up. CSF pressure were (170±22) mm H₂O,（185±21）mm H₂O,（182±23）mm H₂O in the treatment group and （202±22）mm H₂O,（211±24）mm H₂O,（188±21）mm H₂O in the control group, in which t=-3.329, t=-2.436, P＜0.05 when compared 1 and 3 months’results. WBC were（74±13）×10⁶/L, （58±13）×10⁶/L,（39±10）×10⁶/L in the treatment group and （115±16）×10⁶/L，（85±10）×10⁶/L，（55±12）×10⁶/L in the control group (t=-5.190, t=-5.173, t=-5.173，P<0.001). Protein content were （0.52±0.32）g/L,（1.00±0.41）g/L,（0.45±0.28）g/L in the treatment group and（0.89±0.45）g/L, （2.02±0.67）g/L,（0.75±0.45）g/L in the control group (t=-2.407，t=-3.247，t=-2.434, P<0.05). Glucose content were （2.47±0.58）mmol/L,（2.38±0.50）mmol/L,（2.56±0.52）mmol/L in the treatment group and （2.16±0.54）mmol/L,（1.95±0.47）mmol/L,（2.12±0.51）mmol/L in the control group (t=-2.468，t=-2.476，P<0.05 when compared 3 and 6 months). Chloride content were （119±15）mmol/L,（128±17）mmol/L,（129±16）mmol/L in the treatment group and （110±14）mmol/L,（115±18）mmol/L,（124±17）mmol/L in the control group (t=-2.441，P<0.05 compared 3 months). After 6 months of follow-up from leaving hospital, 6 cases in the treatment group were cured, 7 cases were effective and 4 cases died. In the contrast control group, 5 cases were cured, 6 cases were effective and 7 cases died. All patients in the treatment group were treated with the cerebrospinal fluid lavage replacement for 6.5 times, among which 3 cases were suffered from side effects including brief chills, transient fever and convulsions. All side effects disappeared after symptomatic treatment. Conclusion  Cerebrospinal fluid lavage replacement is an effective, simply practicable and safe treatment for severe tuberculous hydrocephalus. This treatment may reduce the mortality of severe tuberculous hydrocephalus and the further study is necessary.

Key words: Tuberculosis, meningeal/complications, Hydrocephalus, Ventricular drainage, Irrigation