长程脑室外引流治疗艾滋病合并新型隐球菌性脑膜炎颅高压

Clinical efficacy and safety of long-term external ventricular drainage in treatment of AIDS patients with cryptococcal meningitis and intracranial hypertension

摘要:

目的 探讨长程脑室外引流术在艾滋病（AIDS）合并新型隐球菌性脑膜炎（CM）颅高压患者中的临床疗效及安全性。方法 选取2022年11月至2025年3月于深圳市第三人民医院接受治疗的50例AIDS合并CM颅高压患者为研究对象，按照随机数表法分为观察组（长程脑室外引流术）和对照组（传统脑室外引流术），各25例。所有患者均接受标准抗真菌、抗AIDS治疗，并进行相应的颅内压监测。比较两组患者的临床疗效和并发症发生情况（颅内感染、出血、引流管渗液等）。结果 观察组的总有效率96.00%，对照组的总有效率80.00%，两者比较差异无统计学意义（P>0.05）；观察组的并发症发生率低于对照组（4.00% vs. 36.00%, P=0.013），其中颅内感染、出血及引流管渗液的发生率均低于对照组。结论 长程脑室外引流术在AIDS合并CM颅高压患者中的应用具有较好的安全性，可有效降低术后并发症发生率，并能减少手术次数，维持颅内压正常稳定，值得临床应用推广。

Abstract:

Objective To investigate the clinical efficacy and safety of long-term external ventricular drainage in AIDS patients with cryptococcal meningitis （CM） and intracranial hypertension.Methods A total of 50 AIDS patients with CM and intracranial hypertension who were treated in Shenzhen Third People’s Hospital from November 2022 to March 2025 were enrolled as subjects， and they were randomly divided into observation group （long-term external ventricular drainage） and control group （traditional external ventricular drainage）， with 25 patients in each group. All patients received standard antifungal and anti-AIDS treatment and intracranial pressure monitoring. The two groups were compared in terms of clinical outcome and complications （intracranial infection， bleeding， and drainage tube leakage）.Results There was no significant difference in overall response rate between the observation group and the control group （96.00% vs 80.00%， P >0.05）. Compared with the control group， the observation group had a significantly lower incidence rate of complications than the control group （4.00% vs 36.00%， P = 0.013）， as well as significantly lower incidence rates of intracranial infection， bleeding， and drainage tube leakage.Conclusion Long-term external ventricular drainage has good safety in AIDS patients with CM and intracranial hypertension and can effectively reduce the incidence rate of postoperative complications and the number of surgeries and maintain a normal and stable intracranial pressure， and therefore， it holds promise for clinical application.