目的 探讨七叶皂苷钠联合尿激酶和地塞米松治疗结核性脑膜炎的临床疗效。方法 选取2011年4月-2014年4月在河北省胸科医院接受治疗的结核性脑膜炎患者76例，随机分为对照组和治疗组，每组各38例。对照组向髓鞘内注射地塞米松磷酸钠注射液，2.5 mg/次，前4周：2次/周，然后1次/周；并髓鞘内注入注射用尿激酶，10万单位/次，1次/d。治疗组在对照组基础上静脉输注注射用七叶皂苷钠，20 mg加入到5%葡萄糖溶液250 mL，1次/d。两组患者均治疗8周。观察两组的临床疗效，比较两组脑脊液中细胞数、蛋白质、葡萄糖、氯化物和颅内压的变化。结果 治疗后，对照组和治疗组的总有效率分别为78.95%、94.74%，两组比较差异有统计学意义（P<0.05）。治疗后，两组脑脊液中细胞数、蛋白质和颅内压均显著下降，而葡萄糖和氯化物水平均明显升高，同组治疗前后比较差异有统计学意义（P<0.05）；且治疗组这些观察指标的改善程度明显优于对照组，两组比较差异具有统计学意义（P<0.05）。结论 七叶皂苷钠联合尿激酶和地塞米松治疗结核性脑膜炎具有较好的临床疗效，可明显改善脑脊液中各项指标，具有一定临床推广应用价值。

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.