论文部分内容阅读
本文报告130例青少年及成人的结核性脑膜炎早期诊断问题。发病率0.93%,占内科结核病人的8.0%。男女比例为1:2.6。年龄以21—30岁占最多数(57例);其次是12—20岁(43例)。临床检查发现有脑膜外结核病者计69例(53.1%)。其中血行播散性肺结核16例。病后10日内确诊开始治疗者占37.9％;超过16日者则有45.7%之多。自起病至确诊开始治疗平均为18.6日。延误早期诊断的主要原因是临床医生对早期诊断的知识与经验不足。早期临床表现有:有或没有受凉等诱因,起病缓慢,持续性并日渐加重的头痛和发热,其次是呕吐及嗜睡。早期体征不明显。可能只有颈抗力增加或克匿格氏征阳性。白细胞总数及分类均正常。脑脊液:压力常增加、透明、蛋白及细胞数增加,氯化物减少;糖减少亦可能正常。对疑似病例,试验性治疗,值得采用。
This article reports the early diagnosis of tuberculous meningitis in 130 adolescents and adults. The incidence of 0.93%, accounting for 8.0% of tuberculosis patients. The ratio of male to female is 1: 2.6. The age of 21-30 years old accounted for the largest number (57 cases); followed by 12-20 years old (43 cases). Clinical examination found that there are 69 cases of extra-nal tuberculosis (53.1%). Among them, 16 cases of hematogenous disseminated pulmonary tuberculosis. Within 10 days after onset of diagnosis and treatment of patients accounted for 37.9%; more than 16 were 45.7%. From the onset of diagnosis to the treatment of an average of 18.6 days. The main reason for the delay in early diagnosis is the clinician’s lack of knowledge and experience of early diagnosis. Early clinical manifestations are: with or without the incentive, slow onset, persistent and increasing headache and fever, followed by vomiting and lethargy. Early signs are not obvious. It may be that only the resistance to the cervix increases or the positive for the Kendig’s sign. The total number of leukocytes and normal classification. Cerebrospinal fluid: the pressure is often increased, transparent, protein and cell number increased chloride reduced; reduced sugar may also be normal. For suspected cases, experimental treatment, it is worth using.