本文關(guān)鍵詞：87例兒童結(jié)核性腦膜炎并腦積水的臨床特征分析　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 兒童 結(jié)核性腦膜炎 腦積水 臨床特征 危險因素

【摘要】：目的:探討兒童結(jié)核性腦膜炎并發(fā)腦積水的臨床資料,并分析影響其近期預(yù)后的相關(guān)因素。方法:對2011年1月至2016年12月重慶醫(yī)科大學(xué)附屬兒童醫(yī)院收治的87例結(jié)核性腦膜炎并發(fā)腦積水患兒病例資料進(jìn)行回顧性分析。結(jié)果:(1)本研究87例兒童結(jié)核性腦膜炎并腦積水中,5歲占60%、5-10歲占24%、10歲占16%,其中嬰幼兒占44%。64%來自農(nóng)村。(2)59%(51/87)有卡介苗接種史,34%(30/87)無卡介苗接種史,余卡介苗接種史不詳。38%(33/87)有明確結(jié)核接觸史,其中61%(20/33)為嬰幼兒。87%(76/87)合并顱外結(jié)核,均合并肺結(jié)核(100%,76/76)。(3)臨床分期為早期、中期、晚期分別占15%(13/87)、31%(27/87)、54%(47/87)。74%(64/87)腦積水出現(xiàn)在病程4周以內(nèi),確診時CT/MRI的檢查次數(shù)為1~3次。(4)臨床癥狀按陽性率從高到低依次為:發(fā)熱(94%,82/87)、顱高壓癥狀(86%,75/87)、其他結(jié)核中毒癥狀(83%,72/87)、意識障礙(83%,72/87)、驚厥(61%,51/87)、精神行為異常(17%,15/87)、不自主運動(13%,13/87)、大小便失禁(5%,4/87)、失語(2%,2/87)。神經(jīng)系統(tǒng)體征按陽性率從高到低依次為:腦膜刺激征(83%,72/87)、癱瘓(67%,58/87)、巴氏征(62%,54/87)、顱神經(jīng)麻痹(47%,41/87)。其中顱神經(jīng)麻痹以面神經(jīng)(59%,24/41)、動眼神經(jīng)(54%,22/87)受損最常見,其次為外展神經(jīng)(15%,6/41)、視神經(jīng)(10%,4/41)。(5)35%(27/77)找到腦脊液病原學(xué)證據(jù),腦脊液涂片、培養(yǎng)陽性率分別為18%、27%。(6)60%(46/77)臨床疑診結(jié)核性腦膜炎的患兒首次行腦脊液檢查呈典型改變。(7)頭顱影像學(xué)(MRI/CT)檢查以基底節(jié)病變(72%/33%)、腦實質(zhì)病變(83%/29%)、腦池改變(39%/5%)、腦膜改變(24%/3%)為主要表現(xiàn)。(8)單因素分析顯示:臨床分期、驚厥、意識障礙、腦膜刺激征、巴氏征、癱瘓、住院時間、鞘內(nèi)注射、抗結(jié)核治療在預(yù)后上的差異具有統(tǒng)計學(xué)意義(P0.05)。經(jīng)多因素logistic回歸分析后顯示臨床分期(P=0.006,OR=3.888,95%CI 1.486~10.167)、意識障礙(P=0.026,OR=14.238,95%CI 3.827~147.122)是兒童結(jié)核性腦膜炎并腦積水近期預(yù)后不良的危險因素,鞘內(nèi)注射(P=0.006,OR=0.148,95%CI 0.039~0.572)是兒童結(jié)核性腦膜炎并腦積水近期預(yù)后的保護(hù)因素。結(jié)論:1.兒童TBMH多見于5歲以下兒童,特別是嬰幼兒,主要來自農(nóng)村。2.以發(fā)熱、嘔吐、驚厥、意識障礙、腦膜刺激征、巴氏征、癱瘓、顱神經(jīng)損害為突出臨床表現(xiàn)。3.頭顱MRI檢查效果優(yōu)于CT。4.合并顱外結(jié)核以肺結(jié)核最常見。5.絕大部分臨床分期為中晚期,腦積水出現(xiàn)時間以病程4周內(nèi)常見。6.臨床分期、驚厥、意識障礙、腦膜刺激征、巴氏征、癱瘓與近期預(yù)后不良有關(guān)。住院時間延長、鞘內(nèi)注射、規(guī)范抗結(jié)核治療可改善預(yù)后。其中臨床分期、意識障礙是獨立危險因素,鞘內(nèi)注射是獨立保護(hù)因素。
[Abstract]:Objective: to investigate the clinical data of tuberculous meningitis complicated with hydrocephalus in children. The factors related to its short-term prognosis were analyzed. Methods:. From January 2011 to December 2016, 87 cases of tuberculous meningitis complicated with hydrocephalus in Children's Hospital affiliated to Chongqing Medical University were retrospectively analyzed. 1) 87 children with tuberculous meningitis complicated with hydrocephalus. Among them, 44% of infants (44%) came from rural areas and 51% (51 / 87) had a history of BCG inoculation (5 years old, 60%, 5-10 years old, 24 cases, 10 years old, 16 cases), in which 44% of the infants came from the countryside, and 51% of them had BCG vaccination history. There was no history of BCG vaccination, while the history of BCG inoculation was not known. 38% (33 / 87) had a history of contact with tuberculosis. Among them, 61R / 20 / 33) is infantile. 87% 76 / 87) complicated with extracranial tuberculosis. All of them are complicated with pulmonary tuberculosis (100%). The clinical stage is early and middle stage. The late stage accounted for 13 / 87 / 31 of 27 / 87 / 54 / 47 / 87 / 74, respectively. Hydrocephalus appeared within 4 weeks of the course of the disease. At the time of diagnosis, the number of CT/MRI examinations was 1 / 3. 4) the positive rate of clinical symptoms from high to low was as follows: fever 94 / 82 / 87, cranial hypertension 86 / 87). Other TB poisoning symptoms 832 / 87, conscious disorders 82 / 87, convulsions 61 / 87, mental and behavioral disorders 17 / 87). 13 / 87% of involuntary exercise, 5 / 87% of incontinence in feces and urine, and 2% of aphasia. The positive rate of nervous system signs from high to low was 83% of meningeal stimulation, 67% of 87% of paralysis, 62% of pasteurization and 54% 87% of pasteurization). The cranial nerve palsy is 41 / 87. The most common type of cranial nerve palsy is the facial nerve 59 / 41, the oculomotor nerve 54 / 87) and the oculomotor nerve 542 / 87). The next is the abducent nerve 15 / 41, the optic nerve 1010 / 4 / 41t / 45 / 77) and the cerebrospinal fluid (CSF) smear, the evidence of cerebrospinal fluid (CSF) pathogeny is found, and the cerebrospinal fluid (CSF) smear is obtained. The positive rate of culture was 18%. Patients suspected of tuberculous meningitis underwent cerebrospinal fluid (CSF) examination for the first time. 72 / 33). Brain parenchymal lesions, brain cisterns, brain cisterns, brain cisterns, brain cisterns, brain cisterns, meningeal changes, and 24 / 3, as the main manifestation, single factor analysis showed: clinical staging, convulsion, and disturbance of consciousness. Meningeal stimulation, pasteurization, paralysis, length of stay, intrathecal injection. The difference in prognosis of anti-tuberculosis therapy was statistically significant (P 0.05). The clinical staging was demonstrated by multivariate logistic regression analysis (P0. 006) and OR3. 888 (P < 0. 006). 95 CI 1.486 ~ 10.167%, and the disturbance of consciousness is 0.026 ~ 14.238. 95 CI 3.827 ~ 147.122) is the risk factor of poor prognosis in children with tuberculous meningitis and hydrocephalus. 95 CI 0.039 0. 572) is a protective factor for children with tuberculous meningitis and hydrocephalus. Conclusion TBMH in children is more common in children under 5 years of age, especially in infants. Mainly from rural areas. 2. With fever, vomiting, convulsion, disturbance of consciousness, meningeal stimulation sign, pasteurization sign, paralysis. Cranial nerve damage was prominent clinical manifestation .3.The effect of MRI was better than that of CT.4.The most common type of pulmonary tuberculosis was tuberculosis. Most of the clinical stages were middle and late stage. Clinical stage, convulsion, disturbance of consciousness, meningeal stimulation sign, pasteurization sign, paralysis were related to the poor prognosis in the near future, prolonged hospitalization and intrathecal injection. Standard antituberculous therapy can improve prognosis, among which clinical stage, consciousness disorder is an independent risk factor, intrathecal injection is an independent protective factor.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R529.3;R742.7

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