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结核性脑膜炎在结核病中发病率高,易漏误诊,而早期诊断及合理治疗可减少后遗症和死亡率。结合我们近年收治的69例结核性脑膜炎,对其诊治进行探讨。1 临床资料1.1 一股资料病例均为我院1992年1月至1999年12月住院病人,结合临床表现、脑脊液生化、细菌学检查、血清学检查及抗痨治疗有效等进行诊断。其中男42例,女27例,年龄12～49岁,平均40岁。合并脑外结核67例,合并两个部位以上结核25例。1.2 主要临床表现发热58例,头痛56例,呕吐51例,脑膜刺激征55例,意识障碍17例,颅神经损害8例,肢体瘫痪3例,关节肿痛14例,结节红斑4例。1.3 治疗方法①抗痨药物的应用:利福平0.6g/d,乙胺丁醇1.0g/d,吡嗪酰胺1.5g/d,强化期异烟肼0.6～0.9g/d静注,维持期异烟肼0.3g/d。②慢放脑脊液(CSF)+椎管内给药。放CSF20～30ml后注入生理盐水20～30ml+氟美松10
Tuberculous meningitis in tuberculosis in high incidence, easy to misdiagnosis, and early diagnosis and reasonable treatment can reduce the sequelae and mortality. Combined with our recent treatment of 69 cases of tuberculous meningitis, its diagnosis and treatment to be explored. 1 clinical data 1.1 a data case were hospitalized from January 1992 to December 1999 inpatients, combined with clinical manifestations, cerebrospinal fluid biochemistry, bacteriological examination, serological tests and anti-tuberculosis treatment effective diagnosis. Including 42 males and 27 females, aged 12 to 49 years old, average 40 years old. 67 cases of merger of extracerebral tuberculosis, tuberculosis in more than two parts combined 25 cases. 1.2 The main clinical manifestations of fever in 58 cases, headache in 56 cases, vomiting in 51 cases, meningeal irritation in 55 cases, 17 cases of disturbance of consciousness, cranial nerve damage in 8 cases, limb paralysis in 3 cases, joint pain in 14 cases, 4 cases of erythema nodosum. 1.3 treatment ① anti-tuberculosis drugs: rifampicin 0.6g / d, ethambutol 1.0g / d, pyrazinamide 1.5g / d, intensive isoniazid 0.6 ~ 0.9g / d intravenous maintenance Isoniazid 0.3g / d. ② slow release of cerebrospinal fluid (CSF) + intraspinal administration. CSF 20 ~ 30ml after injection of saline 20 ~ 30ml + mefloxacin 10