结核性脑膜脑炎126例临床分析  

Clinical Analysis of 126 Patients with Tuberculous Meningoencephalitis

作　　者：廖剑敏[1] 文川[1] 唐晓燕[1] 

机构地区：[1]四川大学华西医院呼吸内科,四川成都610041

出　　处：《中国呼吸与危重监护杂志》2010年第4期383-385,共3页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的总结结核性脑膜脑炎的临床特点。方法回顾分析2000年1月至2009年4月在四川大学华西医院住院治疗的结核性脑膜脑炎患者126例,总结其临床特点及实验室检查结果。结果临床表现有发热、头痛、呕吐、偏瘫、截瘫、精神异常、视力减退、耳聋、复视、抽搐、昏迷、不完全性动眼神经麻痹等,其中有呕吐症状25例(19.8%)。从发病到确诊的时间在8周以上31例(24.6%)。在院期间总体病死率14.3%(18/126),复治患者的住院病死率42.9%(6/14);预后欠佳的病例(在院死亡、自动出院的患者)中,合并血性播散型肺结核的比例达68.3%(28/41),高于整体平均水平的41.3%(52/126)。结论结核性脑膜脑炎要求较高的诊断条件,同时因为症状不典型等原因,导致诊断和治疗不及时,病死率高,尤其是合并血性播散型肺结核者及复治患者。目前缺乏能明显改善预后的治疗方案。Objective To investigate the clinical features of tuberculous meningoencephalitis.Methods The clinical characteristics and laboratory results of 126 cases who were diagnosed as tuberculous meningoencephalitis from January 2000 to April 2009 were analyzed retrospectively.Results The clinical manifestations of tuberculous meningoencephalitis included fever,headache,vomitting,hemiparalysis,paraplegia,mental anomaly,hypopsia,deafness,diplopia,muscular spasms,coma,and incomplete oculomotor palsy,etc.Vomitting which was characteristic symptom of tuberculous meningoencephalitis was found in 25 cases（19.8%）.The diagnosis was confirmed more than eight weeks after the onset of the disease in 31 cases（24.6%）.The inhospital mortality rate of tuberculous meningoencephalitis was 14.3% （18/126）.The inhospital mortality rate of re-treatment patients was 42.9%（6/14）.In 41 patients with poor prognosis （death or therapy failure）,68.3% （28/41） cases were complicated with military tuberculosis,which was higher than the overall occurrence of 41.3% （52/126）.Conclusions Strict diagnostic criteria and atypical symptoms lead to delayed diagnosis,delayed treatment,and high mortality in patients with tuberculous meningoencephalitis,particularly in patients with military tuberculosis and re-treatment patients.There is still no effective treatment which have a significant impact on the prognosis.

关 键 词：结核 结核性脑膜炎 结核性脑膜脑炎 

分 类 号：R725.1[医药卫生—儿科]