成人化脓性脑膜炎临床特点与诊治分析

Clinical characteristics and treatment of purulent meningitis in adults

目的分析探讨成人化脓性脑膜炎的临床特点,提高成人化脓性脑膜炎的诊治水平。方法回顾性分析医院2007年1月-2011年12月收治的26例成人化脓性脑膜炎患者的临床资料。结果患者入院后根据脑脊液生化检查结果诊断化脓性脑膜炎,脑脊液细菌培养阳性16例,其中肺炎链球菌感染9例,大肠埃希菌及肺炎杆菌感染各2例,金黄色葡萄球菌、肺炎克雷伯菌、表皮葡萄球菌感染各1例;经抗感染治疗后,患者住院3～25d,平均住院天数12d;好转23例,死亡3例。结论成人化脓性脑膜炎的多有明确的病因,临床表现不特异,脑脊液及颅脑影像学检查有助于诊断,根据脑脊液细菌培养及药敏结果给予抗菌药物治疗,可以取得一定效果。

OBJECTIVE To analyze the clinical characteristics of purulent meningitis in adults so as to improve the level of diagnosis and treatment of the purulent meningitis in the adults.METHODS A total of 26cases of adult patients with purulent meningitis,who were treated in the hospital from Jan 2007to Dec 2011,were ebrolled in the study,then the clinical data of the patients were retrospectively analyzed.RESULTS The purulent meningitis was diagnosed with cerebral spinal fluid（CSF）biochemical test results after the patient were enrolled,the bacterial culture of cerebrospinal fluid was positive in 16cases,among which there were 9cases with Streptococcus pneumoniaeinfections,2cases with Escherichia coli infections,2cases with Pneumobacillus infections,1case with Staphylococcus aureus infections,1case with Klebsiella pneumoniae infections,and 1case with Staphylococcus epidermidis infections.After the anti-infection therapy,the hospitalization duration varied from 3days to 25days with the mean time of 12days,23cases improved,and 3cases died.CONCLUSION There are many definite causes of purulent meningitis in the adults,and the clinical manifestations are atypical.The cerebrospinal fluid and brain imaging test is conducive to the diagnosis,and the use of antibiotics on the basis of bacterial culture of CSF and the result of drug susceptibility testing can achieve certain effect.