358例儿童结核性脑膜炎临床分析

发布时间：2018-05-26 02:32

本文选题：结核性脑膜炎 + 儿童　；参考：《重庆医科大学》2012年硕士论文

【摘要】：目的通过总结儿童结核性脑膜炎(简称结脑)的临床特征,提高对儿童结核性脑膜炎的认识和诊断水平,以减少误诊。方法回顾性分析2006.01.012010.12.31重庆医科大学附属儿童医院358例符合结核性脑膜炎临床诊断标准的住院病例资料。结果(1)全组病例中,6月婴儿占10.1%,6月～1岁占11.5%,1-3岁占21.8%,5岁以下儿童占56.1%,其中60%来自农村；(2)本组儿童有结核接触史138例,占40.0%,婴幼儿47.7%有结核接触史；(3)45.3%无卡介苗接种史或接种失败,2岁以下儿童接种卡介苗能明显改善结核性脑膜炎预后；(4)儿童结核性脑膜炎常以发热、头痛、咳嗽、呕吐、抽搐为首发症状；(5)48%1临床疑诊结核性脑膜炎患儿的首次脑脊液检查即呈典型改变；(6)脑脊液抗酸杆菌涂片、培养阳性率分别为30.3%、33%；(7)头颅CT、MRI检查阳性率分别为88.9%、89.2%,以脑积水、基底节病变、脑实质结节状环状阴影为主要改变,两者对不同时期异常病变的检出率均无显著差别；(8)预后不良与发病年龄小、未使用糖皮质激素及鞘注、临床晚期有关,其中是否使用糖皮质激素、鞘注是影响结核性脑膜炎预后的重要因素。结论(1)儿童结核性脑膜炎常见临床表现为发热、结核中毒症状、颅内压增高、脑实质损害及脑膜刺激征；(2)结核性脑膜炎好发于婴幼儿,卡介苗接种史、结核病人接触史为儿童结核性脑膜炎诊断的重要线索,年龄越小,价值越大；(3)疑似结核性脑膜炎儿童应及时行脑脊液、头颅影像学检查,胸部X线或CT检查可以为诊断提供重要的参考价值；(4)对于儿童结核性脑膜炎早诊断、早治疗与预后密切相关。
[Abstract]:Objective to improve the understanding and diagnosis of tuberculous meningitis in children by summarizing the clinical features of tuberculous meningitis in children and to reduce misdiagnosis. Methods the data of 358 cases of tuberculous meningitis in children's hospital affiliated to Chongqing Medical University on December 31, 2006.01.012010.12.31 were analyzed retrospectively. Results (1) of the total cases, 10.1 was in 6 months, 11.5 in June, and 56.1 in children under 5 years of age, 60% of whom came from rural areas. 138 children had a history of contact with tuberculosis. 47.7% of infants had history of tuberculosis exposure and 45.3% of children under 2 years old had no history of BCG vaccination or failed BCG vaccination. BCG vaccination could significantly improve the prognosis of tuberculous meningitis. Children with tuberculous meningitis often had fever, headache, cough and vomiting. The first cerebrospinal fluid examination of children with suspected tuberculous meningitis showed typical changes in cerebrospinal fluid (CSF) smear of acid-fast bacilli. The positive rates of culture were 30.33T3333TX / 7) the positive rates of CT MRI were 88.9and 89.2respectively. Hydrocephalus and basal ganglion lesions were the main causes of the disease. The nodule ring shadow of cerebral parenchyma was the main change. There was no significant difference in the detectable rate of abnormal lesions between the two groups.) the poor prognosis was associated with the younger age, the absence of glucocorticoid and sheath injection, and the late clinical stage. Whether glucocorticoid is used or not, sheath injection is an important factor influencing prognosis of tuberculous meningitis. Conclusion 1) the common clinical manifestations of tuberculous meningitis in children are fever, symptoms of tuberculosis poisoning, increased intracranial pressure, cerebral parenchyma damage and meningeal stimulation. The contact history of tuberculosis patients is an important clue for the diagnosis of tuberculous meningitis in children. The younger the age, the greater the value. Chest X-ray or CT examination can provide an important reference value for diagnosis of tuberculous meningitis in children. Early treatment and prognosis are closely related to the diagnosis of tuberculous meningitis in children.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1

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