25例停药时脑脊液仍异常的社区获得性急性细菌性脑膜炎的临床和脑脊液随访

发布时间：2018-05-27 07:35

本文选题：社区获得性急性细菌性脑膜炎 + 停药　；参考：《南京医科大学学报(自然科学版)》2017年07期

【摘要】：目的:总结停药时脑脊液仍异常的社区获得性急性细菌性脑膜炎(community acquired acute purulent meningitis,CAAPM)的临床和脑脊液特点,探讨治疗后无症状仅脑脊液异常的CA-APM是否可以停药及停药条件。方法:回顾性分析25例停药时脑脊液仍异常的CA-APM的临床和脑脊液随访资料,所有患儿随访6个月了解预后。结果:25例患儿均符合CA-APM诊断标准,抗菌药物治疗后体温已平稳(7~14 d),无神经系统阳性症状、体征,外周血白细胞及C-反应蛋白正常,血液和脑脊液培养阴性,头颅影像正常或脑萎缩或硬膜下积液2次检查无增多,无其他发现,但脑脊液仍异常,表现为白细胞(30~200)×106个/L,中性粒细胞1.8%~18.0%,糖1.51~4.12 mmol/L,蛋白0.12~1.80 g/L;予以停药并随访6个月,生长发育正常,硬膜下积液吸收,其中17例分别在停药后(14~50 d)复查脑脊液逐渐恢复正常。结论:部分CA-APM治疗后无症状、体征,达到推荐疗程,且热退7 d以上,外周血炎症指标正常,血及脑脊液培养阴性,脑脊液蛋白水平下降及脑脊液葡萄糖1.51 mmol/L,头颅影像正常或脑萎缩或硬膜下积液2次检查无明显增多,无其他发现,可以尝试停药,减少抗菌药物应用。
[Abstract]:Objective: to summarize the clinical and cerebrospinal fluid (CSF) characteristics of community acquired acute purulent meningitis (CAAPM) with abnormal cerebrospinal fluid (CSF) at the time of withdrawal, and to explore whether the CA-APM with asymptomatic cerebrospinal fluid abnormality after treatment can be stopped and the condition of withdrawal. Methods: the clinical and cerebrospinal fluid (CSF) follow-up data of 25 cases of CA-APM with abnormal CSF at the time of withdrawal were analyzed retrospectively. All the patients were followed up for 6 months to understand the prognosis. Results all 25 cases met the diagnostic criteria of CA-APM. The body temperature was stable at 714 days after antimicrobial therapy. There were no nervous system positive symptoms, signs, normal peripheral blood leukocytes and C-reactive protein, negative blood and cerebrospinal fluid culture. There was no increase in brain image or brain atrophy or subdural effusion twice, but cerebrospinal fluid was still abnormal, manifested as leukocyte 30 / L) 脳 10 6 / L, neutrophilic neutrophils 1. 8% / L, glucose 1. 51% 4. 12 mmol / L, protein 0. 1212 g / L, followed up for 6 months. The growth and development were normal and the subdural effusion was absorbed. In 17 cases, cerebrospinal fluid gradually returned to normal at 1450 days after drug withdrawal. Conclusion: after partial CA-APM treatment, the symptoms and signs reached the recommended course of treatment, and the fever retreated more than 7 days, the peripheral blood inflammation index was normal, and the blood and cerebrospinal fluid culture were negative. The level of cerebrospinal fluid protein decreased and cerebrospinal fluid glucose 1.51 mmol / L, the brain image was normal or brain atrophy or subdural effusion was not significantly increased twice, no other discovery, we can try to stop the drug, reduce the use of antimicrobial drugs.
【作者单位】：南京医科大学附属儿童医院神经内科;
【基金】：南京医科大学科技发展基金面上项目(2015NJMU074)
【分类号】：R725.1

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