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目的 探讨结核性脑膜炎 (TBM )患儿早期出现呼吸节律改变的机制及其临床意义。方法 将 34例TBM ,5 9例化脓性脑膜炎 ,112例中毒性脑炎及 10 2例病毒性脑炎患儿分为 4组 ,进行呼吸节律的临床观察及头颅CT检查 ,并分析其与病理、预后的相关性。结果 4组患儿的呼吸节律改变发生率依次是 79.4% ,13.5 % ,11.6 %和 14.7% ;头颅CT脑积水改变的发生率分别是 88.2 % ,15 .2 % ,1.7%和 1.9% ,各组与TBM比较均P <0 .0 1,TBM的呼吸节律改变及CT改变可出现于病程的早期。结论 79.4%的TBM患儿可出现明显的呼吸节律改变 ,其中 5 5 .88%为病程早期 ,其发生机制除与TBM的病变以脑底明显这一病理改变有关外 ,主要与其早期出现的脑积水、脑室扩张密切相关。这一临床特征及其CT改变均可作为TBM早期诊断的线索 ,在与其它脑炎的鉴别诊断上也有重要意义。
Objective To investigate the mechanism and clinical significance of respiratory rhythm changes in children with tuberculous meningitis (TBM) at early stage. Methods Thirty-four patients with TBM, 59 cases of purulent meningitis, 112 cases of toxic encephalitis and 102 cases of viral encephalitis were divided into 4 groups, the clinical observation of respiratory rhythm and CT scans were performed. Pathology, prognosis of the correlation. Results The incidences of respiratory rhythm changes in the four groups were 79.4%, 13.5%, 11.6% and 14.7%, respectively. The incidences of head CT hydrocephalus were 88.2%, 15.2%, 1.7% and 1.9% respectively, Each group compared with TBM P <0. 01, respiratory changes in TBM and CT changes can appear early in the course of the disease. Conclusion 79.4% of children with TBM may have obvious respiratory rhythm changes, of which 55.88% of the early course of the disease, its mechanism of occurrence in addition to TBM lesions in the brain with obvious pathological changes, mainly associated with its early brain Hydrocephalus, ventricular expansion is closely related. This clinical feature and its CT changes can be used as a clue for the early diagnosis of TBM, also has important significance in the differential diagnosis with other encephalitis.