The application of lumbar and ventricular drainage in the treatment of intracranial hypertension on patients with AIDS and cryptococcal meningitis

Abstract

Objective To investigate the therapeutic effects of lumbar and ventricular drainage in the treatment of intracranial hypertension on acquired immunodeficiency syndrome (AIDS) patients with cryptococcal meningitis (CM).  Methods A retrospective study was conducted on 138 cases of CM with intracranial hypertension, including 36 human immunodeficiency virus (HIV)-positive cases and 102 HIV-negative cases. All patients were given anti-infectious drugs. In drainage group, patients (N = 76, including 17 HIV-positive cases and 59 HIV-negative cases) were treated with lumbar, modified lumbar or ventricular drainage. In non-drainage group, patients (N = 62, including 19 HIV-positive cases and 43 HIV-negative cases) were treated with anti-fungal drugs by intrathecal injection through lumbar puncture. Comparative observation was done on indwelling catheter time, cryptococcal clearance time and complications between drainage and non-drainage groups, as well as HIV-positive and HIV-negative subgroups.  Results The intracranial hypertension symptoms were improved significantly within one week in drainage group. The first indwelling catheter median time in drainage group was 30 (17, 35) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [28 (15, 32) d vs 30 (18, 35) d; U = -1.459, P = 0.144]. The cryptococcal clearance median time in drainage group was 41 (26, 58) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [46 (28, 66) d vs 36 (21, 45) d; U = -1.608, P = 0.108]. The cryptococcal clearance median time in non-drainage group was 42 (32, 65) d, and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [52 (38, 68) d vs 39 (30, 62) d; U = -0.401, P = 0.688]. However, there was significant difference between drainage and non-drainage groups (U = -2.117, P = 0.034). The total effective rate of drainage group was 86.84% (66/76), and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [14/17 vs 89.83% (53/59); χ² = 0.172, P = 0.678]. The total effective rate of non-drainage group was 72.58% (45/62), and there was no statistically significant difference between HIV-positive and HIV-negative subgroups [8/19 vs 86.05% (37/43); χ² = 0.023, P = 0.880]. There was significant difference between drainage and non-drainage groups (χ² = 4.413, P = 0.036).  Conclusions Using lumbar or ventricular drainage to treat AIDS patients with CM in the early stage can effectively control intracranial hypertension, shorten the duration of symptoms, and significantly improve the clinical efficacy.

DOI: 10.3969/j.issn.1672-6731.2016.08.006