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目的:分析中枢神经系统感染患者的临床特征,并提出适当的治疗对策。方法:选取2007年1月—2012年12月期间以发热待查收治入院的中枢神经系统感染患者97例病例资料,其类型为病毒性脑膜炎48例、结核性脑膜炎28例、化脓性脑膜炎12例和隐球菌性脑膜炎9例,分析和比较这4种脑膜炎患者的一般资料、临床表现以及脑脊液(CSF)和外周血象的变化情况。结果:97例中枢神经系统感染患者中,病毒性脑膜炎患者所占比例高于其他类型脑膜炎(P<0.05),其患者发病年龄低于其他类型(P<0.01),患者意识障碍的发生率低于其他类型(P<0.05),其CSF葡萄糖和氯化物值接近正常;化脓性脑膜炎患者的体温高于其他类型(P<0.01),其发生意识障碍、颈项强直及病理征阳性率高于其他类型(P<0.01),其血白细胞(WBC)计数、CSF细胞数均高于其他类型(P<0.01),且其CSF细胞以多核细胞为主;隐球菌性脑膜炎患者的发病年龄高于其他类型(P<0.01),其热程长于其他类型(P<0.01),热程时间低于其他类型(P<0.01),患者视物模糊的发生率高于其他类型(P<0.01);结核性脑膜炎患者的CSF蛋白定量高于其他类型(P<0.01),其氯化物含量低于其他类型(P<0.01)。结论:根据各类脑膜炎患者的临床表现、CSF和外周血象检查结果,按不同类型的脑膜炎采用不同的抗菌药物治疗。
Objective: To analyze the clinical features of patients with central nervous system infection and to propose appropriate treatment strategies. Methods: A total of 97 cases of central nervous system infection admitted to hospital with fever from January 2007 to December 2012 were enrolled, of which 48 were viral meningitis, 28 tuberculous meningitis and purulent meningitis 12 cases of inflammation and 9 cases of cryptococcal meningitis. The general information, clinical manifestations and changes of cerebrospinal fluid (CSF) and peripheral blood were analyzed and compared among these 4 meningitis patients. Results: Among the 97 patients with CNS infection, the proportion of patients with viral meningitis was higher than other types of meningitis (P <0.05), and their age of onset was lower than other types (P <0.01) The rate of CSF glucose and chloride in the patients with purulent meningitis was higher than that in other types (P <0.01), and the incidence of disturbance of consciousness, neck stiffness and pathological positive rate (P <0.01). The count of WBC and the number of CSF cells in CSF were higher than those in other types (P <0.01), and the CSF cells were dominated by multinuclear cells. The incidence of cryptococcal meningitis (P <0.01). The thermal duration was longer than other types (P <0.01), the thermal duration was lower than other types (P <0.01), and the incidence of blurred vision in patients was higher than other types (P < 0.01). The CSF protein of patients with tuberculous meningitis was higher than that of other types (P <0.01), and its chloride content was lower than other types (P <0.01). Conclusion: According to the clinical manifestations, CSF and peripheral blood biopsy results of various meningitis patients, different types of meningitis were treated with different antimicrobial agents.