成人再发性化脓性脑膜炎28例临床特征分析

Clinical features of relapsing purulent meningitis in 28 adult cases

目的探讨成人再发性化脓性脑膜炎(PM)的临床特征。方法回顾性分析28例成人再发性PM(观察组,A组)的临床特征及治疗方法,并与随机纳入的41例首发性PM(对照组,B组)进行对照分析。结果 28例再发性PM患者中,存在脑脊液漏21例(75.00%),有头外伤史14例(53.57%),脑部肿瘤手术史9例(32.15%),与B组比较差异有统计学意义(P<0.05);腰穿脑脊液外观呈乳白色、米泔样或黄色浑浊,实验室明确,20例致病菌中以葡萄球菌所致比例最高(9例,45.00%),肺炎球菌3例(15.00%),绿脓杆菌2例(10.00%),与B组有所不同。合并脑积水3例,2例进行了脑室外引流联合经脑室应用抗生素和地塞米松治疗,疗效满意。结论成人再发性PM主要为有脑脊液漏的患者,合并脑积水者可采用脑室外引流联合经脑室用药的治疗方案。

Objective To investigate clinical characteristics of relapsing purulent meningitis（PM）in adults. Methods We retrospectively analyzed the clinical features of 28 adult cases with relapsing PM（observation group, group A）and randomly recruited 41 controls with first-onset PM（control group,group B）. Results Of 28 cases in group A,21 cases（75%）had cere- brospinal fluid leakage,and 14 cases（53.57%）showed history of brain trauma and 9 cases（32.15%）had operation history of brain tumor,all of which showed statistical differences compared with group B（P〈0.05）. Cerebrospinal fluid acquired by lumbar puncture presented milky white, rice water-like or yellow turbid appearances. Diagnosed by laboratory test, staphylococcus aureus（9 cases, 45% ）had the highest proportion in pathogenic bacteria in group A, followed by pneumococcus（3 cases, 15 % ） and pseudomonas aeruginosa（2 cases, 10% ）,all of which were different from group B. There were three cases complicated with hydrocephalus and two cases of them who received external ventricular drainage combined with antibiotics and dexamethasone treatment got satisfactory curative effects. Conclusion Relapsing purulent meningitis（PM）in adults may have the main feature of cerebrospinal fluid leakage,and cases complicated with hydrocephalus can receive external ventricular drainage and ventricle medication.