儿童脑脓肿37例临床特征和治疗随访

Clinical characteristics and follow up of treatment in 37 cases of brain abscess in children

目的 阐明儿童脑脓肿临床特征，探讨脑脓肿的治疗方法。方法 对３７ 例经ＣＴ和ＭＲＩ确诊为脑脓肿的患儿临床特征进行分析，对疗效进行观察，对其中２３ 例进行病后３ 个月～５ 年的随访。结果 ３７ 例患儿中未查到原发感染灶的２９ 例（７８％ ） ，以癫痫为首发症状者２０ 例（５４ ％） ，头痛者１８ 例（４９％ ） ，发热者１３ 例（３５％ ） 。３０ 例经保守治疗１１ 例治愈，１２ 例好转，总有效率７７％ ；７ 例采取外科治疗，１ 例治愈，３ 例好转。随访８ 例治愈者，５ 例仍保持治愈，余３ 例未经影像复查者亦无异常临床发现；随访１３ 例好转者，６ 例转为治愈，１ 例复发，１ 例遗留有右侧偏瘫，余５ 例未经影像复查者无异常临床发现。结论 儿童脑脓肿以隐源性脑脓肿居多，临床表现多不典型，保守治疗是本病的主要疗法；随访是评价本病远期疗效的重要手段。

Objective To clarify the clinical characteristics and discuss the treatments of brain abscess in children Method The clinical characteristics were analyzed in 37 patients with brain abscess diagnosed by CT or MRI,and 23 of them were followed up for a period of 3 months to 5 years Results The primary infection focus could not be found in 29 patients (78%) The seisure as the first symptom was present in 20 patients (54%); 13 patients (35%) had fever and 18 (49%) had headache Thirty patients were treated with antibiotics through intravenous injection for 3 to 6 weeks, 11 of them recovered completely, 12 had improvement, the treatment was effective in 77% of the patients; of the 7 patients who received surgery,1 recovered, 3 got improved Eight recovered patients were followed up, in 5 of them there were no abnormal findings on CT and MRI, 3 patients without CT or MRI examination were symptoms free. Six of 13 improved patients recovered completly, 1 patient relapsed, 1 had hemiplegia of the right side, 5 patients without CT or MRI examination had no symptoms. Conclusions The causes of brain abscess in 78% of patients were obscure, so most of clinical symptoms of brain abscess in children may not be representative The conservative treatment is the main therapy Follow up is an important method for evaluating long term effects of brain abscess treatment.