中枢神经系统感染160例临床分析

Clinical Analysis of 160 Patients with CNS Infection

目的探讨各类中枢神经系统感染的临床特点及治疗方法。方法对我院收治的中枢神经系统感染160例的临床资料进行回顾性分析。结果本组诊断为病毒性脑炎（病脑）80例,化脓性脑膜炎（化脑）37例,结核性脑膜炎（结脑）35例,隐球菌性脑膜炎（隐脑）8例。全部予甘露醇、甘油果糖脱水降颅压及对症治疗,其中148例治疗有效,复查脑脊液示化脑、病脑患者脑脊液均恢复正常;结脑患者脑脊液明显好转,糖基本恢复正常;隐脑患者脑脊液3次墨汁涂片检查（-）,糖、氯化物基本正常,脑脊液真菌培养（-）,乳胶凝集试验效价明显下降（1∶8~1∶320）。148例病情好转出院,其中10例遗留颅神经损害和脑积水;12例死亡,病死率7.5%。结论中枢神经系统感染需结合临床表现、脑脊液检查和治疗效果综合进行诊断,对疑似中枢神经系统感染但不能确诊者,可予诊断性治疗,以免延误最佳治疗时机。

Objective To analyze the clinical characteristics and treatment of different types of central nervous system（CNS） infection.Methods The clinical data of 160 patients with CNS infection were retrospectively analyzed.Results Among the 160 patients,80 were viral meningitis（VM）,37 purulent encephalitis（PE）,35 tuberculous meningitis（TBM） and 8 cryptococcal meningitis（CM）.All the patients received Mannitol and Glycericen and fructose for dehydration and releasing ICP and symptomatic treatment,and the treatment was effective in 148 patients.Cerebrospinal fluid（CSF） detected by lumbar puncture was normal in VM and PE patients,and it was improved significantly in TBM patients,with CSF sugar returning to normal;In CM patients,the results of India ink detection of CSF were negative for 3 times,with normal sugar and chlorine in CSF,negative result of CSF fungus culture,and significant decreasing of tite in latex agglutination test（1∶8~1∶320）.148 patients were cured and discharged,10 had remaining cranial nerve lesion and hydrocephalus,12 mortalities,and fatality rate was 7.5%.Conclusion The diagnosis of CNS infection should combine clinical manifestations,CSF detection and effectiveness of the treatment.Diagnostic treatment is needed for the suspected patients with CNS infection difficult to be diagnosed at early stage to avoid missing the best treatment opportunity.