结核性脑膜炎诊治探析.docVIP

结核性脑膜炎诊治探析 　 作者：詹雨林，李国航，陈清荣 【关键词】 结核性脑膜炎；诊断；治疗 ［摘 要］ 目的：研究结核性脑膜炎的临床表现和各项实验室检查结果对结核性脑膜炎的诊断价值，并探讨其治疗，尤其是重症结核性脑膜炎的治疗。方法：对1998年至2005年收治的46例结核性脑膜炎进行了回顾性的研究。结果：46例病人在肺部均可发现结核病灶，其中以发热、头痛起病45例，32例脑脊液白细胞10×106/L~500×106/L，34例蛋白1.0 g/L~5.0 g/L，糖降低21例，氯化物降低27例。24例聚合酶链反应（PCR）检测结核菌DNA（TBDNA），阳性19例。46例治疗好转44例，2例死亡。结论：由于脑脊液中找到结核杆菌的阳性率较低，结核性脑膜炎的诊断仍需综合各方面的临床资料。治疗方面宜注意控制颅内高压，对于陷入重度昏迷的重症患者宜行颅骨钻孔脑脊液引流及冲洗。 　　［关键词］ 结核性脑膜炎；诊断；治疗 　　Clinical Study of Tuberculous Meningitis in Diagnosis and Treatment 　　Abstract：Objective To assess the value of clinical and laboratory in the diagnosis of tuberculous meningitis(TBM),and probe the strategy of treatment,especially in the serious TBM.Methods Retrospective analysis was conducted for 46 patients with TBM during 1998～2005.Results Pulmonary tuberculosis were found in the all patients,initial syndrome of 45 cases were fever and headache,total number of cerebrospinal fluid(CSF) white blood cells of 32 cases were among 10~500×106/L,CSF protein level of 34 cases were among 1.0 g/L~5.0 g/L,CSF glucose level of 21 cases and chloride level of 27 cases were decrease.DNA of mycobacterium tuberculosis was detected by polymerase chain reaction（PCR）in CSF,19 of 24 cases were positive.Through treatment,46 cases were discharged and 2 cases were died.Conclusion Because of lower smearpositive rate of mycobacterium tuberculosis,diagnosis was still dependent on various clinical datas.It is important to recognize and treat intracranial hypertension,burr hole drainage and flush of encephalocoele were the effective methods to save the patients when deep coma of serious cases occurred. 　　Key words：Tuberculous meningitis;Diagnosis;Treatment 近年来，由于结核病疫情的回升，结核性脑膜炎的发病率亦有上升的势头。由于结核性脑膜炎临床表现缺乏特异性，临床上常常引起误诊，重症患者死亡率和致残率仍较高。我院感染科自1998年至2005年收治了46例成人结核性脑膜炎，本文拟对结核性脑膜炎的诊治作一探讨。 　　1 临床资料 　　1.1 一般资料 46例中男性31例，女性15例，年龄17岁~65岁，平均(32.2±10.6)岁。46例病例中外来务工人员40例，均为首发起病，6例本市居民均为未完成抗结核疗程而自行停药而发病。 　　1.2 临床表现 本组病例以发热、头痛起病45例，1例以精神及行为异常为首发症状。在病情中伴呕吐17例，咳嗽12例，盗汗18例，抽搐3例，脑膜刺激征42例，意识障碍20例，脑神经损害4例（外展神