目的 探討七葉皂苷鈉聯(lián)合尿激酶和地塞米松治療結核性腦膜炎的臨床療效。方法 選取2011年4月-2014年4月在河北省胸科醫(yī)院接受治療的結核性腦膜炎患者76例，隨機分為對照組和治療組，每組各38例。對照組向髓鞘內(nèi)注射地塞米松磷酸鈉注射液，2.5 mg/次，前4周：2次/周，然后1次/周；并髓鞘內(nèi)注入注射用尿激酶，10萬單位/次，1次/d。治療組在對照組基礎上靜脈輸注注射用七葉皂苷鈉，20 mg加入到5%葡萄糖溶液250 mL，1次/d。兩組患者均治療8周。觀察兩組的臨床療效，比較兩組腦脊液中細胞數(shù)、蛋白質(zhì)、葡萄糖、氯化物和顱內(nèi)壓的變化。結果 治療后，對照組和治療組的總有效率分別為78.95%、94.74%，兩組比較差異有統(tǒng)計學意義（P<0.05）。治療后，兩組腦脊液中細胞數(shù)、蛋白質(zhì)和顱內(nèi)壓均顯著下降，而葡萄糖和氯化物水平均明顯升高，同組治療前后比較差異有統(tǒng)計學意義（P<0.05）；且治療組這些觀察指標的改善程度明顯優(yōu)于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。結論 七葉皂苷鈉聯(lián)合尿激酶和地塞米松治療結核性腦膜炎具有較好的臨床療效，可明顯改善腦脊液中各項指標，具有一定臨床推廣應用價值。

Objective To investigate the clinical effect of sodium aescinate combined with urokinase and dexamethasone in treatment of tuberculous meningitis. Methods Patients (76 cases) with tuberculous meningitis in Hebei Chest Hospital from January 2013 to February 2015 were randomly divided into control and treatment groups, and each group had 38 cases. Patients in the control group were iv intrathecal administered with Dexamethasone Sodium Phosphate Injection, 2.5 mg/time, the first 4 weeks:twice weekly, then once weekly. Patients in the control group were also iv intrathecal administered with Urokinase for injection, 100 000 U/time, once daily. Patients in the treatment group were iv administered with Sodium Aescinate for injection on the basis of the control group, 20 mg added into 5% glucose solution 250 mL, once daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacies were evaluated, and the changes of cell number, protein, glucose, chloride and intracranial pressure in cerebrospinal fluid in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 78.95% and 94.74%, respectively, and there was difference between two groups (P<0.05). After treatment, cell number and protein of cerebrospinal fluid and intracranial pressure in two groups were significantly decreased, but glucose and chloride of cerebrospinal fluid in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). Conclusion Sodium aescinate combined with urokinase and dexamethasone has clinical curative effect in treatment of tuberculous meningitis, and can significantly improve the various indexes of cerebrospinal fluid, which has a certain clinical application value.