小儿结核性脑膜炎64例早期诊断和误诊原因的分析

目的探讨小儿结核性脑膜炎早期诊断和误诊的原因。方法对我院2003年～2007年收治的小儿结核性脑膜炎64例临床特点、早期诊断、误诊原因等进行分析探讨。结果64例中,有肺结核或脊柱结核的48例占75%,患急性血行播散性肺结核31例占48.4%,有结核病接触史52例占81.2%,其中3岁以下患儿28/52例占53.8%,结核菌素试验阳性51例占79.7%。临床症状以发热、头痛、呕吐等居多;体征:颈强直56例占87.5%,病理反射如巴彬氏症、克尼格氏症、布氏症阳性占60～70%,瘫痪9例占14.1%,眼斜视6例占9.4%,前卤饱满13例占20.3%,口角歪斜9例占14.1%,视力障碍4例占6.2%。院外误诊21例占32.8%,其中误诊为支原体肺炎6例,上感12例,化脓性脑膜炎3例。结论小儿结核性脑膜炎多发生3岁以下,本组占48.4%。有1/3患儿患有粟粒性肺结核,小儿结核性脑膜炎常因诊断不及时或治疗不当而危及生命,故本文就早期诊断和误诊原因进行探讨。

goal： Discusses the young child tubercular meningitis early diagnosis and the error diagnostic reason analysis. Method The young child tubercular meningitis clinical characteristic which, the early diagnosis, the error diagnostic reason 2003 - 2007 admitted to my courtyard and so on carried on the analysis discussion. Finally ： in 64 example young childtubercular meningitis, has pulmonary tuberculosis or the tuberculosis 48 examples accounts for 75%, contracts the acute blood sowing in rows divergence pulmonary tuberculosis 31 exampies to account for 48.4%, has tuberculosis to contact the history 52 examples to account for 81.2%, below 3 years old the baby 28/52 example occupies 53.8% （family contact history to be many）, the tuberculin test masculine gender 51 examples account for 79.7%. The clinical symptoms give off heat, majorities and so on headache, vomit, has losses of appetite, makes a tearful scene, the convulsion, to be addicted to rests, the stupor and so on to occupy about 20 -40% ; Symptom： The neck strong straight 56 examples account for 87.5%, Pathological reflex, such as Babinski＇s （ ＋ ）, Kenig＇s（ ＋ ） , bruzinski＇s？ （ ＋ ）account for 60 -70%, paralyzes 9 examples to account for 14. 1%, the eye squints 6 examples to account for9.4%, the first halogen full 13 examples account for 20. 3%, the argument crooked 9 examples account for 14. 1%, the blurred vision 4 examples account for 6.2%. Outside the courtyard misdiagnoses 21 examples to account for 32. 8%, misdiagneses for the Mycoplasma pneumonia 6 examples accounts for 9. 4%, on the feeling 12 examples account for 18.8%, the suppurative meningitis 3 examples account for 4. 7%. Conclusion The young child tubercular meningitis have below much 3 years old, this group accounts for 48.4%, nearly half. Some 1/3 babies contract the miliary pulmonary tuberculosis,the young child tubercular meningitis because frequently the diagnosis not prompt or treats improper endangers life, therefore this article carries on the discussion on the early diagnosis and the error diagnostic.