脑室-腹腔分流术治疗HIV相关隐球菌性脑膜炎颅内高压

doi:10.3877/cma.j.issn.2095-9141.2021.02.009

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 103 -106. doi: 10.3877/cma.j.issn.2095-9141.2021.02.009

所属专题：文献；

颅脑创伤

脑室-腹腔分流术治疗HIV相关隐球菌性脑膜炎颅内高压

崔亚辉¹, 陈海平¹, 张海鹏¹, 胡昕¹, 喻剑华², 张忠东², 张斌海², 师金川², 闫俊², 张建民³^,^†(

)

^1. 310023　杭州，浙江大学医学院附属杭州市西溪医院神经外科
^2. 310023　杭州，浙江大学医学院附属杭州市西溪医院感染二科
^3. 310009　杭州，浙江大学医学院附属第二医院神经外科

收稿日期:2021-01-19 出版日期:2021-04-15
通信作者: 张建民
基金资助:
广元市科技计划项目(20ZDYF0037)

Ventriculo peritoneal shunt for intracranial hypertension in HIV-associated cryptococcus meningitis

Yahui Cui¹, Haiping Chen¹, Haipeng Zhang¹, Xin Hu¹, Jianhua Yu², Zhongdong Zhang², Binhai Zhang², Jinchuan Shi², Jun Yan², Jianming Zhang³^,^†()

^1. Department of Neurosurgery, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou 310023, China
^2. Second Department of Infection Disease, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou 310023, China
^3. Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China

Received:2021-01-19 Published:2021-04-15
Corresponding author: Jianming Zhang

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引用本文：

崔亚辉, 陈海平, 张海鹏, 胡昕, 喻剑华, 张忠东, 张斌海, 师金川, 闫俊, 张建民. 脑室-腹腔分流术治疗HIV相关隐球菌性脑膜炎颅内高压[J]. 中华神经创伤外科电子杂志, 2021, 07(02): 103-106.

Yahui Cui, Haiping Chen, Haipeng Zhang, Xin Hu, Jianhua Yu, Zhongdong Zhang, Binhai Zhang, Jinchuan Shi, Jun Yan, Jianming Zhang. Ventriculo peritoneal shunt for intracranial hypertension in HIV-associated cryptococcus meningitis[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(02): 103-106.

目的

观察脑室-腹腔（V-P）分流术治疗人类免疫缺陷病毒（HIV）相关隐球菌性脑膜炎（CM）颅内高压的临床疗效。

方法

回顾性分析浙江大学医学院附属杭州市西溪医院感染二科自2015年5月至2019年4月收治的59例HIV相关CM患者的临床资料，其中10例因颅内压高行V-P分流术，同时按指南给予规范的两性霉素B、氟胞嘧啶、氟康唑、伊曲康唑等抗真菌治疗，以颅内压以及颅高压症状改善为观察指标。

结果

所有分流患者术后均停用甘露醇、甘油果糖等降颅压药物，监测颅内压均低于200 mmH₂O（1 mmH₂O=0.0098 kPa）。患者术后头痛、呕吐、意识障碍、癫痫、视乳头水肿等均明显好转。

结论

HIV相关隐球菌性脑膜炎颅内高压需早期积极控制，腰大池引流管放置时间13 d是安全的。早期V-P分流可以有效降低颅内压，改善临床症状，降低死亡率。

关键词: 人类免疫缺陷病毒, 隐球菌性脑膜炎, 颅高压, 脑室-腹腔分流

Objective

To explore the clinical efficacy of ventriculo peritoneal (V-P) shunt for intracranial hypertension in human immunodeficiency virus (HIV)-associated cryptococcus meningitis (CM).

Methods

A retrospective analysis was conducted on the data of 59 HIV-associated CM patients in the Second Department of Infection Disease, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine from May 2015 to April 2019. Among those patients, 10 cases underwent V-P shunt due to intracranial hypertension, meanwhile underwent antifungal therapy including amphotericin B, flucytosine, fluconazole and itraconazole was given according to the guidelines. The intracranial pressure and alleviation of intracranial hypertension symptoms were taken as observation indexes.

Results

All patients with shunt were stopped with mannitol, glycerin fructose and other drugs, and the intracranial pressure was lower than 200 mmH₂O (1 mmH₂O=0.0098 kPa). The headache, vomiting, consciousness disorder, epilepsy, optic papilledema were all improved significantly.

Conclusion

Intracranial hypertension in HIV-associated cryptococcus meningitis should be aggressively treated at early time. It might be safety that placing the lumbago cistern drainage tube for 13 d. Intracranial pressure could be efficiently decreased by V-P shunt in early phase, which could also improve the clinical symptoms and reduce the death rate.

Key words: Human immunodeficiency virus, Cryptococcus meningitis, Cranial hypertension, Ventriculo peritoneal shunt

表1 10例HIV感染合并CM患者的临床资料

患者	性别	年龄（岁）	术前测压（mmH₂O）	术前脑脊液蛋白（mg/L）	发病到分流周期（d）	三脑室最大横径减小（mm)
1	男	37	>400	1794	39	2.4
2	男	28	>400	378	73	0.4
3	男	32	>400	853	20	1.0
4	女	52	300	2280	35	1.2
5	男	27	>400	205	11	1.9
6	男	34	>400	736	30	1.2
7	男	31	300	490	44	1.0
8	女	42	>400	206	43	1.0
9	男	38	350	652	90	1.0
10	男	31	>400	830	145	0.4

表1 10例HIV感染合并CM患者的临床资料

患者	性别	年龄（岁）	术前测压（mmH₂O）	术前脑脊液蛋白（mg/L）	发病到分流周期（d）	三脑室最大横径减小（mm)
1	男	37	>400	1794	39	2.4
2	男	28	>400	378	73	0.4
3	男	32	>400	853	20	1.0
4	女	52	300	2280	35	1.2
5	男	27	>400	205	11	1.9
6	男	34	>400	736	30	1.2
7	男	31	300	490	44	1.0
8	女	42	>400	206	43	1.0
9	男	38	350	652	90	1.0
10	男	31	>400	830	145	0.4

图1 典型患者术前术后的影像学资料

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Ventriculo peritoneal shunt for intracranial hypertension in HIV-associated cryptococcus meningitis

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Ventriculo peritoneal shunt for intracranial hypertension in HIV-associated cryptococcus meningitis