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目的:分析总结小儿结核性脑膜炎的临床特征,探讨早期诊断及预防的方法。方法:回顾性分析2005～2009年大连市儿童医院PICU病房收治的42例临床诊断结核性脑膜炎的住院患儿的病例资料。结果:42例结核性脑膜炎患儿中,年龄小于3岁32例,占76.2%;有明确结核接触史13例,占31.0%;脑脊液不典型19例,占45.2%;结核菌素试验阳性27例,占64.3%。患儿主要表现为发热、颅内压增高、抽搐、意识障碍,9例伴有肺炎、肠炎等其他系统疾病,占21.4%。33例行脑CT检查,26例异常,占78.8%,其中18例伴脑积水改变,占54.5%。结论:诊断结核性脑膜炎应重视结核接触史的询问,发热伴颅内压增高、脑神经损害是小儿结核性脑膜炎的常见表现,脑CT是结核性脑膜炎早期诊断和判断预后比较有效的方法,早期诊断并及时治疗是降低死亡率和致残率的关键。
Objective: To analyze and summarize the clinical features of children with tuberculous meningitis and explore the methods of early diagnosis and prevention. Methods: A retrospective analysis of 42 cases of hospitalized children with tuberculous meningitis diagnosed in PICU ward of Dalian Children’s Hospital from 2005 to 2009 was retrospectively analyzed. Results: Among 42 children with tuberculous meningitis, 32 cases were younger than 3 years old, accounting for 76.2%; 13 cases had clear history of TB contact, accounting for 31.0%; 19 cases were non-cerebrospinal fluid (45.2%); tuberculin test was positive 27 cases, accounting for 64.3%. The main manifestations of children with fever, increased intracranial pressure, convulsions, disturbance of consciousness, 9 cases associated with pneumonia, enteritis and other systemic diseases, accounting for 21.4%. 33 cases of brain CT examination, 26 cases of abnormalities, accounting for 78.8%, of which 18 cases with hydrocephalus changes, accounting for 54.5%. Conclusion: The diagnosis of tuberculous meningitis should pay attention to the history of contact with tuberculosis, fever and increased intracranial pressure, brain damage is a common manifestation of tuberculous meningitis in children, early diagnosis of tuberculous meningitis and prognosis of tuberculous meningitis is more effective Methods, early diagnosis and prompt treatment are key to reducing mortality and morbidity.