200例结核性脑膜炎临床分析

发布时间：2018-02-23 22:22

本文关键词： 结核性脑膜炎临床表现辅助检查不良反应维生素C　出处：《重庆医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨结核性脑膜炎临床表现、脑脊液改变、影像学特点、诊治方法、抗结核药物不良反应及其转归。方法：2009年-2012年重医附一院收治结核性脑膜炎患者200例，，对其病例资料进行回顾性分析。结果：本组200例病例中,以头痛、发热、恶心、呕吐为主要临床表现，病程中出现精神行为异常、大小便障碍、颅神经麻痹、抽搐等症状；脑脊液检查中压力增高者占58%，有核细胞数20-500*106/l居多(75.5%)，糖明显降低（＜50%）占90.5%。MRI阳性率（65.5%）远大于CT阳性率(29%)，发现并发脑梗死者为24.5%；经治疗后172例（86%）病情好转出院，抗结核药物不良反应中肝损害发生比率最高，且预防使用糖水+维生素C对抗结核药物引起肝损害无效。结论：临床医生应从不典型临床表现以及辅助检查等对结核性脑膜炎作出早诊断、早治疗，充分认识结核性脑膜炎合并脑梗死，加大早期治疗力度，减少并发症及后遗症的发生，降低致残率及死亡率，提高治愈率,尽可能降低抗结核药物引起不良反应。
[Abstract]:Objective: to investigate the clinical manifestations, cerebrospinal fluid changes, imaging features, diagnosis and treatment of tuberculous meningitis, antituberculous drug adverse reactions and their outcome. Methods: from 2009 to 2012, 200 cases of tuberculous meningitis were retrospectively analyzed. Results: the main clinical manifestations of 200 cases were headache, fever, nausea and vomiting. In cerebrospinal fluid examination, the pressure increased in 58 patients, the number of nuclear cells 20-500 ~ 106 / l was 75.55.55, the sugar decreased significantly (< 50) and the MRI positive rate was much higher than the CT positive rate of 29.5. It was found that the patients complicated with cerebral infarction were 24.55.The patients with cerebral infarction got better after treatment and were discharged from hospital. The incidence of liver damage was the highest in the adverse reactions of antituberculotic drugs, and the prevention of liver damage caused by antituberculous drugs with sucrose vitamin C was ineffective. Conclusion: clinicians should make early diagnosis and treatment of tuberculous meningitis from atypical clinical manifestations and auxiliary examinations, fully understand tuberculous meningitis with cerebral infarction, and increase the intensity of early treatment. To reduce the incidence of complications and sequelae, to reduce the rate of disability and mortality, to improve the cure rate, and to reduce the adverse reactions caused by anti-tuberculosis drugs as far as possible.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R529.3

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