本文選題：結(jié)核性腦膜炎 + 兒童　； 參考：《重慶醫(yī)科大學》2012年碩士論文

【摘要】：目的通過總結(jié)兒童結(jié)核性腦膜炎(簡稱結(jié)腦)的臨床特征,提高對兒童結(jié)核性腦膜炎的認識和診斷水平,以減少誤診。方法回顧性分析2006.01.012010.12.31重慶醫(yī)科大學附屬兒童醫(yī)院358例符合結(jié)核性腦膜炎臨床診斷標準的住院病例資料。結(jié)果(1)全組病例中,6月嬰兒占10.1%,6月～1歲占11.5%,1-3歲占21.8%,5歲以下兒童占56.1%,其中60%來自農(nóng)村；(2)本組兒童有結(jié)核接觸史138例,占40.0%,嬰幼兒47.7%有結(jié)核接觸史；(3)45.3%無卡介苗接種史或接種失敗,2歲以下兒童接種卡介苗能明顯改善結(jié)核性腦膜炎預(yù)后；(4)兒童結(jié)核性腦膜炎常以發(fā)熱、頭痛、咳嗽、嘔吐、抽搐為首發(fā)癥狀；(5)48%1臨床疑診結(jié)核性腦膜炎患兒的首次腦脊液檢查即呈典型改變；(6)腦脊液抗酸桿菌涂片、培養(yǎng)陽性率分別為30.3%、33%；(7)頭顱CT、MRI檢查陽性率分別為88.9%、89.2%,以腦積水、基底節(jié)病變、腦實質(zhì)結(jié)節(jié)狀環(huán)狀陰影為主要改變,兩者對不同時期異常病變的檢出率均無顯著差別；(8)預(yù)后不良與發(fā)病年齡小、未使用糖皮質(zhì)激素及鞘注、臨床晚期有關(guān),其中是否使用糖皮質(zhì)激素、鞘注是影響結(jié)核性腦膜炎預(yù)后的重要因素。結(jié)論(1)兒童結(jié)核性腦膜炎常見臨床表現(xiàn)為發(fā)熱、結(jié)核中毒癥狀、顱內(nèi)壓增高、腦實質(zhì)損害及腦膜刺激征；(2)結(jié)核性腦膜炎好發(fā)于嬰幼兒,卡介苗接種史、結(jié)核病人接觸史為兒童結(jié)核性腦膜炎診斷的重要線索,年齡越小,價值越大；(3)疑似結(jié)核性腦膜炎兒童應(yīng)及時行腦脊液、頭顱影像學檢查,胸部X線或CT檢查可以為診斷提供重要的參考價值；(4)對于兒童結(jié)核性腦膜炎早診斷、早治療與預(yù)后密切相關(guān)。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R725.1

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