结核性脑膜炎50例临床分析

Tubercular meningitis 50 example clinical analysis

目的：分析结核性脑膜炎的临床特点、诊断经验和治疗方法,减少误诊、漏诊,提高对结核性脑膜炎患者的诊断率和治愈率.方法：对2004年1月～2010年05月住院诊断为结核性脑膜炎的50例病历资料进行回顾性分析.结果：50例患者中男22例,女28例,平均年龄38.3±10.2岁,既往有结核病或结核病接触史者14例（28%）,同时患有肺结核有39例（78%）;急性起病者11例（22%）,亚急性和慢性起病39例（78%）;有结核中毒症状表现32例（64%）,有颅高压表现者24例（48%）,颅神经损害者14例（28%）,意识障碍6例（12%）,精神症状8例（16%）,脑膜刺激征31例（62%）.病原学检查阳性病例4例（8%）,其中脑脊液涂片阳性1例,培养阳性3例;脑脊液检查：颅内压升高26例（52%）.脑脊液细胞分类以淋巴细胞升高为主44例（88%）,蛋白升高36例（72%）,氯化物降低34例（68%）,糖含量下降31例（62%）.神经系统影像学表现：脑膜增厚28例（56%）、脑积水23例（46%）.全部病例均接受抗结核和激素治疗,41例（82%）患者病情好转出院,6例自动出院,死亡3例.结论：结核性脑膜炎的临床表现、脑脊液改变不典型,病原学检查阳性率低,其诊断需结合流行病学资料、临床特点、脑脊液改变以及影像学特征,有效的诊断性抗结核治疗有助诊断.治疗效果与治疗时机密切相关.

Objective：Analyzes the tubercular meningitis the clinical characteristic,the diagnosis experience and the method of treatment, reduces the error diagnostic, leaks examines, enhances to the tubercular meningitis patient＇s diagnosis rate and the cure rate. Methods：2010 years in May is hospitalized to January,2004 the diagnosis to carry on the review analysis for the tubercular meningitis 50 example medical record material. Resuits： In 50 example patients male 22 examples,the female 28 examples,the average age 38.3±10.2 year old, have tuberculosis or tuberculosis formerly contact the history 14 examples （28%）, simultaneously contracts pulmonary tuberculosis to have 39 examples （78 %） ; Acute gets up the getting sick 11 examples （22 %）, the subacute and the ehronicity get up get sick 39 examples （78%） ;Has the tuberculosis to be poisoned the symptom to display 32 examples （64%）, has the skull high pressure performance 24 examples （48%）, the cranial nerve impairer 14 examples （28%）,the consciousness barrier 6 examples （12%）,the energetic symptom 8 examples （16%） ,the meninx stimulation draft 31 examples （62%）. The etiology inspection masculine case of illness 4 examples （8%）,in which eerebrospinal fluid smear masculine gender 1 example,raises the masculine 3 examples;Cerebrospinal fluid inspection：The cerebrospinal fluid pressure elevates 26 examples （52 %）. The cerebrospinal fluid cell classification by the lymphocyte ascension primarily 44 examples （88 %）, the protein elevates 36 examples （72%） ,the chloride reduces 34 examples （68%） ,the sugar content drops 31 examples （62%）. Nervous system phantom study performance. Meninx accumulation 28 examples （56 %）, hydrocephalus 23 examples （46%）. The complete case of illness accepts the anti--tuberculosis and the hormone treatment, 41 example （82 %） patient condition change for the better out of hospital, 6 example automatic outs of hospital,died 3 examples. Conclusion.The tubercular menin- gitis clinical manifestation, the cerebrospinal fluid change is atypical, the etiology inspection masculine gender rate is low, its diagnosis must unify the epidemiology material, the clinical characteristic, the cerebrospinal fluid change as well as the phantom study characteristic, the effective diagnosis anti--tuberculosis treatment is helpful to diagnose. Treat- ment result and treatment opportunity close correlation.