结核性脑膜炎并中重度脑积水的诊断及治疗分析.docVIP

精品论文 参考文献 结核性脑膜炎并中重度脑积水的诊断及治疗分析 贵州省都匀市贵州医科大学第三附属医院感染科 贵州省都匀市邮编：558004 　　【摘要】 目的 研究结核性脑膜炎并中重度脑积水的临床特点、治疗要点及预后转归情况。方法 回顾性分析我科2013年1月至2016年6月收治的8例结核性脑膜炎并中重度脑积水患者的诊治经过，并做出临床经验总结。结果 8例病人中5例预后良好，1例留下右下肢体跛行残疾，1例留下多言、易动、流涎等精神障碍，1例因出现多种抗痨药物过敏等复杂情况而最终导致患者死亡。结论 结核性脑膜炎并中重度脑积水仍是严重危害结核病人身体健康和生命安全的并发症之一，早期、规范合理的综合治疗仍是治疗的关键措施。 　　【关键词】 结核性脑膜炎；脑积水；诊断；治疗 　　Diagnosis and treatment of tuberculous meningitis with moderate and severe hydrocephalus 　　JIANG Tai, YANG Ren-hui,Department of infection. The Third Affiliated Hospital of Guizhou Medical University in Guizhou Province, Tuyun City: 558004 　　【Abstract】Objective To study the clinical characteristics, treatment and prognosis of tuberculous meningitis with moderate and severe hydrocephalus. Methods the diagnosis and treatment of 8 cases of tuberculous meningitis in our department from January 2013 to June 2016 were retrospectively analyzed, and the clinical experience was summarized. Result Eight of the patients in 5 cases had a good prognosis, 1 cases of left right limp disabled, 1 case leave say, mobile, salivation and other mental disorders, 1 case due to the emergence of a variety of anti tuberculosis drug allergies and other complex situations and ultimately leads to death of the patient.Conclusion Tuberculous meningitis with moderate and severe hydrocephalus is still a serious risk to the health and safety of patients with tuberculosis complications, early, standardized comprehensive treatment is still a key measure of treatment. 　　[Key words] Tuberculous meningitis; hydrocephalus; diagnosis; treatment 　　结核性脑膜炎是严重的中枢神经系统感染性疾病，常继发于肺结核，约占全身结核感染的6%[1]，是一种致死率、致残率高的中枢神经系统疾病，如不及时治疗易出现高压性脑积水、脑疝形成，是本病的主要死亡原因。 　　资料与方法 　　一、一般资料 　　1、 8例病人中3例为男性，5例为女性，年龄最大者37岁，最小者为10岁，平均年龄为22.5岁。头颅CT或MRI有轻至重度脑积水，均符合结核性脑膜炎诊断标准[2]。有发热者7例，盗汗者5例，咳嗽咳痰者3例，头痛者6例，呕吐者3例（其中2例为喷射性呕吐），抽搐者1例，昏迷者2例，意识障碍者3例，头昏者1例，左下肢功能障碍者1例，脑膜刺激征阳性者7例，病理征阳性者5例，肢体肌力减退者2例，大小便失禁者3例，体重明显下降者3例。 　　2、辅助检查 8例患者均行胸片或/和胸部CT检查，结果显示并有急性粟粒型肺结核者2例，并有浸润型肺结核者6例。痰涂片阳性者1例，痰TB-DNA阳性者2例。头颅CT或MRI检查提示脑水肿和轻至重度脑