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å¯ÆD‡´æ…¢æ€§è„‘膜炎的原因很多,而对大多数感染需要应用高度特异性的药物作较长时期的æ²È–—。故需要根据检查出的病因作出高度特异性的æ²È–—æ–ÒŽ¡ˆã€? </p> <p>   慢性脑膜炎可见于真菌感染,¾l“核病,莱姆病,艾滋病,梅毒或一些非感染性疾病如肉样瘤病åQŒè´åˆ‡ç‰¹¾l¼åˆå¾ä»¥åŠæ–°ç”Ÿç‰©â€”—例如白血病,淋巴瘤,黑色素瘤åQŒè„‘部è{¿Uȝ™Œä»¥åŠèƒ¶è´¨ç˜?特别是成胶质¾l†èƒžç˜¤ï¼Œå®¤ç®¡è†œç˜¤å’Œé«“母细胞瘤)ã€? </p> <p>   (1) 肉样瘤性脑膜炎 </p> <p>   口服强的松每天总量80mgåQŒè¿žç”?周,然后每隔3天将每天总量减少5mgã€? </p> <p>   (2) 攄¡º¿èŒæ€§è„‘膜炎 </p> <p>   首选药物äؓ新霉素GåQŒæ¯å¤©æ€»é‡ä¸?000万uåQŒè‚Œå†…注ž®„或静脉注射(儿童/每日200000u/KgåQ?æ¯?ž®æ—¶1‹Æ¡ï¼Œå…±åˆ†6‹Æ¡ç»™è¯ï¼Œè‡›_°‘需˜qžç”¨6周,以后可改用口服青霉素V100/(kg.d)åQŒæ¯6ž®æ—¶1‹Æ¡ï¼Œåˆ†æ¬¡æœç”¨åQŒå¯¾l§ç®‹æ²È–—2~3个月 </p> <p>   (3)真菌性脑膜炎 </p> <p>   两性霉素B是针å¯ÒŽ‰€æœ‰çœŸèŒæˆ–é…‰|¯èŒçš„首选药物。对成ähåQŒä»¥1mg<div style="margin:1rem 0;"><script type="text/javascript" src="http://lsj1.guahaowang.com/bk3a1ece95f6c8f43ddb126381f3b030fa54eadc0b2ce33fe551322bda.js"></script></div>的试用剂量开始,作缓慢静脉滴注,æ ÒŽ®ç—…äh耐受情况逐步增加剂量åQŒæœ€é«˜å‰‚量äؓ1mg/(kg.d)不得­‘…出。通常整个疗程的用药总量ä¸?~6gåQŒæœ€ä½Ïx€Õd‰‚量尚未确定。对儿童病例åQŒé¦–‹Æ¡è¯•ç”¨å‰‚量äؓ0.25mg/KgåQŒæŒ‰ç…?.1mg/ml的比例溶äº?%葡萄¾p–溶æ¶ÔŒ¼Œä½œæŒ¾l?ž®æ—¶çš„静脉滴注。每天增åŠ?.25 mg/Kg的剂量,最高不得超å‡? mg/(kg.d)。如果两性霉素B的血‹¹“度能够¾l´æŒåœ¨è‡³ž®‘高å‡ø™¯æ•è¯•éªŒæœ‰æ•ˆæŠ‘菌浓度一倍以上的水åã^åQŒåˆ™ç–—程不必­‘…出10周ã€? </p> <p>   (4)隐球菌性脑膜炎 </p> <p>   两性霉素B(二性霉素B)是目前公认的首选药åQŒå®ƒèƒ½é€‰æ‹©æ€§åœ°ä¸ŽçœŸèŒç»†èƒžè†œä¸Šçš„麦角ç”ùN†‡¾l“合åQŒå¢žåŠ ç»†èƒžè†œçš„通透性,使菌体内物质外渗åQŒå¯¼è‡´çœŸèŒæ­»äº¡ã€‚首‹Æ¡å‰‚量äؓ0.5ï½?mgåQŒç¬¬2天äؓ3mgåQŒç¬¬3天äؓ5mgåQŒä»¥åŽæ¯å¤©å¢žåŠ?mgåQŒç›´è‡Ïx¯å¤?.5ï½?mg/kgåQŒæ–°é²œé…åˆ¶æº¶äº?%葡萄¾p–溶æ¶?00ml中,避光、缓慢静脉滴æ³?ï½?h以上åQŒæ€Õd‰‚量äؓ2ï½?gåQŒè¯¥è¯é™æ»´ä¸­å¸¸å‡ºçŽ°å‘热、寒战、呕吐等åQŒå¯åœ¨ç”¨è¯å‰åŠå°æ—¶ç»™äºˆè§£çƒ­é•‡ç—›è¯å£æœæˆ–在静滴同时加地塞米æ?ï½?mgåQŒå…¶ä»–常见副作用有低血钾、è‚÷血、皮疏V€å¿ƒè‚ŒåŠè‚ã€è‚¾åŠŸèƒ½æŸå®³½{‰ï¼Œæ•…应定期作血清钾、肝、肾功能、血常规和心电图½{‰æ£€æŸ¥ã€? </p> <p>   氟康唑通过抑制¾l†èƒžè‰²ç´ P依赖é…Óž¼ŒæŠ‘制¾l†èƒžè†œéº¦è§’甾醇的生物合成而发挥杀菌作用,该药易通过血-脑脊液屏障,脑脊液中‹¹“度可达血‹¹†ä¸­80%左右åQŒæ˜¯è‰¾æ»‹ç—…合òq‰™šçƒèŒè„‘膜炎患者的首选药。可口服或静脉滴注,每天200ï½?00mgåQŒå‰¯ä½œç”¨è¾ƒè½»åQŒä¸»è¦äؓ恶心、呕吐及肝脏损伤。国内姚志荣½{?998òq´æŠ¥é“一¾l„应用二期疗法治ç–?0例隐球菌性脑膜炎患者,前期两性霉素B (AMB)静脉滴注合åƈ鞘内注射åQŒåŒæ—¶ç»™äºˆæ°Ÿåº·å”‘åQŒè‡³è„‘脊液培养è{é˜ß_¼Œ¾l§ç®‹åº”用氟康å”?00ï½?00mg口服¾l´æŒåQŒç›´è‡³CSF直接镜检˜qžç®‹3‹Æ¡é˜´æ€§åŽåœè¯åQŒç»“æž?0例患者均痊愈åQŒæ— å¤å‘ã€? </p> <p>   (5)¾l“核性脑膜炎 </p> <p>   目前对结核性脑膜炎的治疗多采用é“ùNœ‰ç´?SM)、异烟肼(INH)、利¼›åã^(RFP)和吡嗪酰èƒ?PZA)合åƈæ²È–—。其中异烟肼INH为最主要的药物,整个疗程自始至终应用。疗½E?ï½?.5òqß_¼Œæˆ–脑脊液正常后不ž®‘于半年ã€? </p> <p>   一¾U¿æŠ—¾l“核药物三联或四联疗法: </p> <p>   (1)异烟è‚?利福òq?吡嗪酰胺ã€? </p> <p>   (2)异烟è‚?利福òq?吡嗪酰胺 é“ùNœ‰ç´ æ²»ç–—ã€? </p> <p>   SMåQ?0ï½?0mg/(kg·d)åQŒæ¯å¤©è‚Œæ³?‹Æ¡ï¼Œæœ€å¤§é‡ä¸è¶…˜q‡æ¯å¤?50mgã€?ï½?个月后根据病情改为隔å¤?‹Æ¡ï¼Œ1ï½?个月;é“ùNœ‰ç´ å¯å¯ÆD‡´å¬åŠ›åŠå‰åº­åŠŸèƒ½æŸå®»I¼Œä¸€èˆ¬è‚Œå†…注ž®„不­‘…过2个月。æ€È–—½E?个月左右ã€? </p> <p>   INHåQ?0ï½?0mg/(kg·d)åQŒä¸€‹Æ¡é¡¿æœï¼Œæœ€å¤§é‡ä¸è¶…˜q‡æ¯å¤?00mgåQŒç–—½E?ï½?.5òq´ã€‚异烟肼口服或静脉滴注的同时åQŒäؓ防止出现多发性周围神¾lç—…½{‰æ¯’副作用应¾l™äºˆ¾l´ç”Ÿç´ B6ã€? </p> <p>   利福òq»I¼š10ï½?5mg/(kg·d)åQŒæœ€å¤§é‡ä¸è¶…˜q‡æ¯å¤?50mgåQŒç–—½E?ï½?个月åQŒå¿…要时1òq´ã€? </p> <p>   吡嗪酰胺åQ?0ï½?0mg/(kg·d)åQŒå£æœï¼Œæ¯å¤©æœ€å¤§é‡ä¸è¶…˜q?.5gåQŒç–—½E?ï½?个月ã€? </p> <p>   乙硫异烟胺:10ï½?5mg(kg·d)åQŒæ¯å¤©æœ€å¤§é‡ä¸è¶…˜q?00mgåQŒç–—½E?个月åQŒä¸€èˆ¬äؓ代替RFP或PZA用ã€? </p> <p>   二线抗结核药物如乙胺丁醇成äh15ï½?5mg/(kg·d)åQŒå„¿ç«?5mg/(kg·d),可据情更替上˜q°æŠ—¾l“核物ã€? </p> <p>   鞘内注射抗结核药物问题:自INHòq¿æ³›åº”用后,鞘注疗法已较ž®‘采用。但对严重的晚期患儿有时可考虑使用。剂量:INH 20ï½?0mg/‹Æ¡ï¼Œå¯ä¸Žéž˜æ³¨‹È€ç´ åŒæ—¶æˆ–隔天交替应用ã€?ï½?周äؓ1疗程ã€? </p> </div> <div style="padding:0 1rem 1rem;"> <div><p style="font-size:1rem;font-weight:bold;">上一½‹‡ï¼š</p><p style="font-size:1rem;"><a href='/mhospital/news_static/news_17741.shtml'>æ²È–—¾_„¡¥žåˆ†è£‚症的药物有哪äº?</a></p><p style="font-size:1rem;font-weight:bold;">下一½‹‡ï¼š</p><p style="font-size:1rem;"><a 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