| 摘要: |
| 目的:探讨儿童重症监护病房结核性脑膜炎患儿的临床特征及诊断方法,加强对结核性脑膜炎的早期诊断治疗,改善预后。方法:分析2009-2015年我院两个儿童重症监护病房收治的重症结核性脑膜炎患儿的临床特征、诊断方法和治疗措施。应用小儿危重病例评分对病情进行评估。所有重症结核性脑膜炎患儿均根据病史、实验室检查、影像学检查及国家结核病规划指南中儿童结核病管理明确诊断。结果:34例重症结核性脑膜炎患儿中,6例接种卡介苗但上臂未见卡疤,29例存在脑外结核感染,8例前囟隆起,3例存在动眼神经麻痹,5例存在面瘫,6例诉有视物模糊。结核杆菌感染T细胞斑点试验(T-SPOT.TB)实验29例阳性。5例体液免疫低下,16例存在细胞免疫功能低下。16例存在不同程度的侧脑室扩张,9例丘脑及基底节低密度灶。10例存在大小脑半球脑沟裂稍增宽、加深。6例经未闭前囟行侧脑室穿刺减压,4例患儿行脑脊液侧脑室腹腔分流术。26例好转后转结核病专科医院治疗,5例放弃治疗出院,3例死亡。结论:儿童重症监护病房颅内感染的危重病患儿需警惕重症结核性脑膜炎,T-SPOT.TB试验可作为早期诊断结核性脑膜炎的重要辅助手段,脑脊液脑室穿刺减压或侧脑室腹腔分流术对改善预后有帮助。 |
| 关键词: 重症 结核性脑膜炎 结核杆菌感染T 细胞斑点试验 儿童 重症监护病房 |
| DOI：doi: 10.13407/j.cnki.jpp.1672-108X.2017.12.007 |
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| 基金项目: |
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| Clinical Analysis of Severe Tuberculous Meningitis in Children |
| Zhou Xiong, Zhang Xinping, Xu Zhiyue , Lu Xiulan, Yang Meiyu, Fan Jianghua, Xiao Zhenghui |
| (Children's Hospital of Hunan Province, Hunan Changsha 410007, China) |
| Abstract: |
| Objective: To explore the clinical features and diagnosis methods of children tuberculous meningitis, in order to focus on earlier diagnosis, treatment and improve the prognosis. Methods: All severe tuberculous meningitis cases admitted in PICUs during 2009 to 2015 have been collected and analyzed in clinical characteristics, diagnostic methods and treatment. Patients had been evaluated by pediatric critical illness score (PCIS). All cases were diagnosed to severe tuberculous meningitis according to the history, lab results and imaging examination which was consistent in the management of tuberculosis in children under the guideline of national TB programs. Results: There were 34 cases of severe tuberculous meningitis. Bacillus Calmette-Guerin scars were absent in 6 cases, twenty-nine cases were complicated in extra-cerebral tuberculosis infection, bregmatic eminance had been seen in 8 cases, three cases had oculomotor nerve palsy, 5 cases had facial paralysis, blurred vision had been complained by 6 cases. Positive T cell enzyme-linked immunospot assay test for tubercle bacillius (T-SPOT. TB) could be found in 29 cases. Five cases had humoral immunocompromised and
16 cases had cellular immunocompromised. Sixty cases had lateral ventricle expansion, 9 cases showed lower density in thalamus and basal ganglia. Ten cases existed bigger or deeper cerebral fissure. Six cases had been processed in lateral ventricle puncture decompression and 4 cases had ventriculo-peritoneal shunt procedures. Twenty-six cases had been improved and transferred to specialized TB institutions. Five cases were abandoned and left hospital voluntarily, 3 cases died. Conclusion: Severe tuberculous
meningitis should be vigilant in intracranial infection case of PICU. T-SPOT. TB can be used as important auxiliary means of early diagnosis in tuberculous meningitis. Lateral ventricle puncture decompression and ventriculo-peritonealshunt procedures are helpful to improve the prognosis. |
| Key words: severe tuberculous meningitis T cell enzyme鄄linked immunospot assay test for tubercle bacillius children intensive care unit |
