Schoeman J, Donald P, van Zyl L, Keet M, Wait J
Department of Paediatrics and Child Health, University of Stellenbosch, Medical School, Republic of South Africa.
Dev Med Child Neurol. 1991 May;33(5):396-405. doi: 10.1111/j.1469-8749.1991.tb14899.x.
The effect of different treatment regimes on intracranial pressure (ICP), degree of hydrocephalus and clinical outcome was evaluated in 81 children with tuberculous meningitis. 24 children underwent CSF shunting, while 57 with communicating hydrocephalus were randomly assigned to three treatment groups: antituberculous drugs only; or additional intrathecal hyaluronidase or oral acetazolamide and furosemide in addition to antituberculous treatment. The addition of acetazolamide and furosemide was significantly more effective in achieving normal ICP than antituberculous drugs alone. No difference was found in mortality or number of disabled survivors between groups. Of those surviving, nearly two-thirds with stage II tuberculous meningitis were mildly disabled and nearly one-half with stage III were severely disabled at follow-up, emphasising the need for early diagnosis of tuberculous meningitis in the young child.
在81例结核性脑膜炎患儿中评估了不同治疗方案对颅内压（ICP）、脑积水程度及临床结局的影响。24例患儿接受了脑脊液分流术，而57例交通性脑积水患儿被随机分为三个治疗组：仅接受抗结核药物治疗；除抗结核治疗外，额外接受鞘内注射透明质酸酶或口服乙酰唑胺和呋塞米治疗。与仅使用抗结核药物相比，加用乙酰唑胺和呋塞米在使ICP恢复正常方面显著更有效。各组间死亡率或残疾幸存者数量无差异。在存活者中，随访时近三分之二的Ⅱ期结核性脑膜炎患儿有轻度残疾，近一半的Ⅲ期患儿有重度残疾，这强调了幼儿结核性脑膜炎早期诊断的必要性。
